Causes of Lymphedema
List of causes of Lymphedema
Following is a list of causes or underlying conditions
(see also Misdiagnosis of underlying causes of Lymphedema)
that could possibly cause Lymphedema includes:
More causes:
see full list of causes for Lymphedema
Causes of Lymphedema (Diseases Database):
The follow list shows some of the possible medical causes of Lymphedema
that are listed by the Diseases Database:
Source: Diseases Database
Lymphedema Causes: Book Excerpts
Lymphedema as a complication of other conditions:
Other conditions that might have
Lymphedema as a complication may,
potentially, be an underlying cause of Lymphedema.
Our database lists the following as having
Lymphedema as a complication of that condition:
Lymphedema as a symptom:
Conditions listing Lymphedema
as a symptom may also be potential underlying causes of Lymphedema.
Our database lists the following as having
Lymphedema as a symptom of that condition:
Related information on causes of Lymphedema:
As with all medical conditions,
there may be many causal factors.
Further relevant information on causes of Lymphedema may be found in:
Causes of Lymphedema: Online Medical Books
16 MEDICAL BOOKS ONLINE!
Review excerpts from medical books online, free, without registration,
for more information about the causes of Lymphedema.
Lymphadenopathy:
Differential Diagnosis
(In a Page: Signs and Symptoms)
Generalized lymphadenopathy (e.g., cervical, supraclavicular, axillary, and inguinal lymphadenopathy; hepatomegaly; splenomegaly)
-
Infection
–Tuberculosis
–Secondary syphilis
–Mononucleosis
–HIV/AIDS
–Kawasaki's syndrome
–Typhoid fever -
Hypersensitivity reactions
–Serum sickness
–Drugs (e.g., hydantoin, phenytoin, hydralazine, allopurinol, primidone)
-
Lymphoma
-
Leukemia
-
Connective tissue disorders (e.g., SLE, rheumatoid arthritis)
-
Sarcoidosis
-
Metastatic cancer [especially with left supraclavicular lymphadenopathy (Virchow's node) associated with abdominal malignancies, including stomach, pancreas, gallbladder, testis/ovary, kidney, and prostate cancers]
-
Endocrine disorders (e.g., hyperthyroidism, hypoadrenalism)
-
Amyloidosis
-
Castleman's syndrome (angiofollicular lymph node hyperplasia)
-
Kikuchi's disease
Localized lymphadenopathy
-
Reactive hyperplasia, local inflammation (e.g., dermatitis, vaccination, trauma)
-
Infection
–Viral: Mononucleosis, CMV, HIV, rubella, mumps
–Bacterial: Streptococcus, tuberculosis, salmonella, cat-scratch disease (due to Bartonella henselae); gonorrhea, Chlamydia, and other sexually transmitted diseases (inguinal)
–Parasitic: Malaria, toxoplasmosis
–Fungal: Histoplasmosis,
coccidioidomycosis
- Lymphoma or metastatic disease (e.g. head
and neck squamous cell cancer leads to
cervical lymphadenopathy)
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Periorbital Edema:
Differential Diagnosis
(In a Page: Signs and Symptoms)
-
Conjunctivitis
-
Allergy
–Systemic (e.g., reaction to medication,
urticaria/angioedema)
–Local (e.g., insect bite)
-
Contact dermatitis/dermatitis medicamentosa
-
Chalazion
–Zeis or Meibomian gland obstruction of eyelid
-
Orbital disease (see “Proptosis/Exophthalmos” entry)
-
Preseptal/periorbital cellulitis
-
Acute dacryocystitis (infection of the lacrimal ducts)
-
Orbital fat herniation through attenuated or dehiscent orbital septum and/or orbicularis oculi muscle (aging changes)
-
Herpes simplex/zoster
-
Blepharitis/dermatitis
-
Trauma/postsurgical (e.g., orbital fracture)
-
Dermatomyositis/polymyositis
–Associated with a heliotropic (violet colored) rash on the upper eyelids
-
Chemical, ultraviolet, or thermal burn
-
Cardiac failure (generalized edema)
-
Renal failure
-
Nephrotic syndrome
-
Blepharitis/rosacea
-
Dacryoadenitis
-
Hypothyroidism
–Associated with fatigue, pretibial edema, and delayed relaxation of reflexes
-
Superior vena cava syndrome
-
Sebaceous gland carcinoma
-
Squamous or basal cell carcinoma
-
Discoid lupus
-
Ocular cicatricial pemphigoid (symblepharon)
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Peripheral Edema:
Differential Diagnosis
(In a Page: Signs and Symptoms)
- Venous insufficiency
–Caused by incompetent venous valves
–Skin characteristically has superficial varicose veins associated with a reddish-brown pretibial discoloration (“venous stasis skin changes”)
–Swelling is typically worse after legs are held in a dependent position and is least noticeable after a night's sleep
-
Congestive heart failure
–Associated with pitting peripheral edema
–Other signs of heart failure include a third
heart sound, cardiomegaly, and hepatomegaly
-
Cellulitis
–Usually unilateral
–Edematous legs are typically red, warm,
and inflamed
–The patient may exhibit signs of systemic toxicity with fever and leukocytosis
- Deep venous thrombosis
–Typically unilateral swelling
–May exhibit a palpable cord representing a thrombosed vein
–Homan's sign (pain in the calf with passive dorsiflexion of the foot)
–Virchow's triad (hypercoagulable states, venous stasis, and vessel injury) are risk factors
- Cirrhosis
–Advanced liver disease results in hypoalbuminemia and poor venous return through cirrhotic liver tissue
–Other stigmata of chronic liver disease include caput medusae, ascites, and spider angiomata
-
Nephrotic syndrome
–Glomerular damage results in protein loss and decreased oncotic pressure
-
Less common etiologies (“zebras”) include filariasis (lymphatic infection by Wuchereria bancrofti worm), myxedema (seen in patients with severe hypothyroidism), Milroy's disease (congenital lymphedema), chronic lymphedema (e.g., lymphatic damage due to surgery, such as vein harvesting for CABG), and gout
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Edema:
Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)
-
Kidney disease (nephrotic syndrome)
–Insidious onset, periorbital and lower extremity edema, abdominal distension
–Various types include minimal change disease (MCNS), focal segmental glomerulosclerosis, acute and chronic glomerulonephritis
-
Chronic renal failure from any cause may result in impaired fluid excretion
-
Liver disease from any cause resulting in impaired production of albumin
-
Congestive heart failure (CHF)
-
Protein losing enteropathy
–Menetrier disease (typically CMV), inflammatory bowel disease, neuroblastoma, intestinal lymphangiectasia, trypsinogen deficiency
-
Celiac disease
-
Sepsis, with capillary leak (movement of fluid out of the blood vessels into the interstitium)
-
Hereditary angioneurotic edema
–Intermittent swelling of extremities
–Often preceded by trauma
–Decreased C4 and C1 esterase inhibitor
-
Rocky Mountain spotted fever
-
Stevens-Johnson syndrome
-
Vitamin E deficiency
-
Hypothyroidism
-
Severe malnutrition
–Marasmus (calorie deficiency)
–Kwashiorkor (protein deficiency)
-
Zinc deficiency
-
Hydrops fetalis
-
Impaired lymphatic drainage
–Milroy disease
–Meigs syndrome
–Yellow nail syndrome
–Lymphedema praecox
-
Filariasis (nematode infection resulting in elephantiasis)
-
Immobility including placement of body casts and paralysis
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
Lymphadenopathy:
Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)
- Infectious
–Viral (URI, varicella, EBV, CMV, HIV, rubella, mumps, measles)
–Bacterial (strep, staph, mycobacterium, atypical mycobacterium, brucellosis, tularemia, syphilis, chlamydia)
–Fungal (histoplasmosis, coccidioidomycosis)
–Protozoal (toxoplasmosis, malaria)
–Scalp infection
-
Allergy
–Seasonal or individual
-
Inflammatory
–Kawasaki disease
–Sarcoidosis
–Cat-scratch disease (Bartonella henselae)
–Drug-induced (phenytoin, isoniazid,
hydralazine, dapsone, procainamide, allopurinol)
-
Malignancy
–Leukemia
–Hodgkin disease
–Non-Hodgkin lymphoma
–Neuroblastoma
–Rhabdomyosarcoma
–Histiocytic disorder
-
Collagen vascular disease or systemic illness
–Rheumatoid arthritis
–Systemic lupus erythematosus
–Serum sickness
–Autoimmune hemolytic anemia
–Cystic fibrosis
-
Immunodeficiency
-
Storage diseases
–Gaucher disease
–Niemann-Pick disease
-
Non-lymph node masses simulating
lympadenopathy
–Thyroglossal duct cysts
–Branchial cleft cysts
–Cystic hygroma
–Hemangioma
–Teratoma
–Thymoma
–Inguinal hernia
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
Periorbital Edema:
Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)
- Periorbital cellulitis
–Also described as preseptal cellulitis (infection is anterior to the orbital septum and thus does not affect the orbit or globe)
–Usual pathogens are streptococcal species, Staphylococcus aureus, and Haemophilus influenzae
- Orbital cellulitis
–Also described as postseptal and affects the preseptal structures as well as the extraocular muscles and the optic nerve
–Bacterial pathogens are the same as periorbital cellulitis and may reflect direct spread
–May be accompanied by orbital abscess and may spread via the sinuses to the brain
-
Other infections
–Conjunctivitis
–Sinusitis
–Dental abscess
-
Allergic reaction
–Conjunctivitis
–Urticaria/angioedema
–Drug reaction
-
Local ocular causes
–Insect bites
–Contact dermatitis
–Trauma
–Foreign body
-
Systemic disorders with generalized edema
–Hypoproteinemia
–Renal disease
–Congestive heart failure
-
Malignancy
–Neuroblastomas: Associated with ecchymoses, “raccoon eyes,” and proptosis
–Leukemia: Associated with fever, fatigue, anemia, bone pain, lymphadenopathy, splenomegaly
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
Edema, generalized:
Medical causes
(Handbook of Signs & Symptoms (Third Edition))
Angioneurotic edema or angioedema
Recurrent attacks of acute, painless, nonpitting edema involving the skin and mucous membranes — especially those of the respiratory tract, face, neck, lips, larynx, hands, feet, genitalia, or viscera — may be the result of a food or drug allergy or emotional stress or they may be hereditary. Abdominal pain, nausea, vomiting, and diarrhea accompany visceral edema; dyspnea and stridor accompany life-threatening laryngeal edema.
Burns
Edema and associated tissue damage vary with the severity of the burn. Severe generalized edema (4+) may occur within 2 days of a major burn; localized edema may occur with a less severe burn.
Heart failure
Severe, generalized pitting edema — occasionally ana-
sarca — may follow leg edema late in this disorder. The edema may improve with exercise or elevation of the limbs and is typically worse at the end of the day. Among other classic late findings are hemoptysis, cyanosis, marked hepatomegaly, clubbing, crackles, and a ventricular gallop. Typically, the patient has tachypnea, palpitations, hypotension, weight gain despite anorexia, nausea, a slowed mental response, diaphoresis, and pallor. Dyspnea, orthopnea, tachycardia, and fatigue typify left-sided heart failure; jugular vein distention, enlarged liver, and peripheral edema typify right-sided heart failure.
Malnutrition
Anasarca in malnutrition may mask dramatic muscle wasting. Malnutrition also typically causes muscle weakness; lethargy; anorexia; diarrhea; apathy; dry, wrinkled skin; and signs of anemia, such as dizziness and pallor.
Myxedema
With myxedema, which is a severe form of hypothyroidism, generalized nonpitting edema is accompanied by dry, flaky, inelastic, waxy, pale skin; a puffy face; and an upper eyelid droop. Observation also reveals masklike facies, hair loss or coarsening, and psychomotor slowing. Associated findings include hoarseness, weight gain, fatigue, cold intolerance, bradycardia, hypoventilation, constipation, abdominal distention, menorrhagia, impotence, and infertility.
Nephrotic syndrome
Although nephroticsyndrome is characterized by generalized pitting edema, it's initially localized around the eyes. With severe cases, anasarca develops, increasing body weight by up to 50%. Other common signs and symptoms are ascites, anorexia, fatigue, malaise, depression, and pallor.
Pericardial effusion
With pericardial effusion, generalized pitting edema may be most prominent in the arms and legs. It may be accompanied by chest pain, dyspnea, orthopnea, a nonproductive cough, a pericardial friction rub, jugular vein distention, dysphagia, and a fever.
Pericarditis (chronic constructive)
Resembling right-sided heart failure, pericarditisusually begins with pitting edema of the arms and legs that may progress to generalized edema. Other signs and symptoms include ascites, Kussmaul's sign, dyspnea, fatigue, weakness, abdominal distention, and hepatomegaly.
Renal failure
With acute renal failure, generalized pitting edema occurs as a late sign. With chronic renal failure, edema is less likely to become generalized; its severity depends on the degree of fluid overload. Both forms of renal failure cause oliguria, anorexia, nausea and vomiting, drowsiness, confusion, hypertension, dyspnea, crackles, dizziness, and pallor.
Other causes
Drugs
Any drug that causes sodium retention may aggravate or cause generalized edema. Examples include antihypertensives, corticosteroids, androgenic and anabolic steroids, estrogens, and nonsteroidal anti-inflammatory drugs, such as phenylbutazone, ibuprofen, and naproxen.
Treatments
I.V. saline solution infusions and internal feedings may cause sodium and fluid overload, resulting in generalized edema, especially in patients with cardiac or renal disease.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Lymphadenopathy:
Medical causes
(Handbook of Signs & Symptoms (Third Edition))
Acquired immunodeficiency syndrome
Besides lymphadenopathy, findings include a history of fatigue, night sweats, afternoon fevers, diarrhea, weight loss, and a cough with several concurrent infections appearing soon afterward.
Anthrax (cutaneous)
Lymphadenopathy, malaise, a headache, and a fever may develop along with a lesion that progresses into a painless, necrotic-centered ulcer.
Brucellosis
Generalized lymphadenopathy usually affects cervical and axillary lymph nodes, making them tender
Brucellosis usually begins insidiously with easy fatigability, malaise, headache, backache, anorexia, weight loss, and arthralgia; it may also begin abruptly with chills, a fever that usually rises in the morning and subsides during the day, and diaphoresis.
Cytomegalovirus infection
Generalized lymphadenopathy occurs in the immunocompromised patient and is accompanied by a fever, malaise, a rash, and hepatosplenomegaly.
Hodgkin’s disease
The extent of lymphadenopathy reflects the stage of malignancy — from stage I involvement of a single lymph node region to stage IV generalized lymphadenopathy
Common early signs and symptoms include pruritus and, in older patients, fatigue, weakness, night sweats, malaise, weight loss, and an unexplained fever (usually to 101° F [38.3° C]). Also, if mediastinal lymph nodes enlarge, tracheal and esophageal pressure produces dyspnea and dysphagia.
Leptospirosis
Lymphadenopathy occurs infrequently in leptospirosis, a rare disease
More common findings include a sudden onset of a fever and chills, malaise, myalgia, a headache, nausea and vomiting, and abdominal pain.
Leukemia (acute lymphocytic)
Generalized lymphadenopathy is accompanied by fatigue, malaise, pallor, and a low-grade fever
The patient also experiences prolonged bleeding time, swollen gums, weight loss, bone or joint pain, and hepatosplenomegaly.
Leukemia (chronic lymphocytic)
Generalized lymphadenopathy appears early, along with fatigue, malaise, and a fever
As the disease progresses, hepatosplenomegaly, severe fatigue, and weight loss occur. Other late findings include bone tenderness, edema, pallor, dyspnea, tachycardia, palpitations, bleeding, anemia, and macular or nodular lesions.
Lyme disease
Spread by the bite of certain ticks, Lyme disease begins with a skin lesion called erythema chronicum migrans
As the disease progresses, the patient may suffer from lymphadenopathy, constant malaise and fatigue, and an intermittent headache, a fever, chills, and aches. He may go on to develop arthralgia and, eventually, neurologic and cardiac abnormalities.
Mononucleosis (infectious)
Characteristic, painful lymphadenopathy involves cervical, axillary, and inguinal nodes. Posterior cervical adenopathy is also common. Typically, prodromal symptoms — such as a headache, malaise, and fatigue — occur 3 to 5 days before the appearance of the classic triad of lymphadenopathy, sore throat, and temperature fluctuations with an evening peak of about 102° F (38.9°C). Hepatosplenomegaly may develop, along with findings of stomatitis, exudative tonsillitis, or pharyngitis.
Mycosis fungoides
Lymphadenopathy occurs in stage III of mycosis fungoides, a rare, chronic malignant lymphoma
It’s accompanied by ulcerated brownish red tumors that are painful and itchy.
Non-Hodgkin’s lymphoma
Painless enlargement of one or more peripheral lymph nodes is the most common sign of non-Hodgkin’s lymphoma, with generalized lymphadenopathy characterizing stage IV
Dyspnea, a cough, and hepatosplenomegaly occur, along with systemic complaints of a fever of up to 101° F (38.37 C), night sweats, fatigue, malaise, and weight loss.
Plague (Yersinia pestis)
and symptoms of the bubonic form of plague, a bacterial infection, include lymphadenopathy, a fever, and chills.
Rheumatoid arthritis
Lymphadenopathy is an early, nonspecific finding associated with fatigue, malaise, a continuous low-grade fever, weight loss, and vague arthralgia and myalgia
Later, the patient develops joint tenderness, swelling, and warmth; joint stiffness after inactivity (especially in the morning); and subcutaneous nodules on the elbows. Eventually joint deformity, muscle weakness, and atrophy may occur.
Sarcoidosis
Generalized, bilateral hilar and right paratracheal forms of lymphadenopathy (seen on chest X-ray) with splenomegaly are common
Initial findings are arthralgia, fatigue, malaise, weight loss, and pulmonary symptoms. Other findings vary with the site and extent of fibrosis. Typical cardiopulmonary findings include breathlessness, a cough, substernal chest pain, and arrhythmias. About 90% of patients have an abnormal chest X-ray at sometime during their illness. Musculoskeletal and cutaneous features may include muscle weakness and pain, phalangeal and nasal mucosal lesions, and subcutaneous skin nodules. Common ophthalmic findings include eye pain, photophobia, and nonreactive pupils. Central nervous system involvement may produce cranial or peripheral nerve palsies and seizures.
Sjögren’s syndrome
Lymphadenopathy of the parotid and submaxillary nodes may occur in Sjögren’s syndrome, a rare disorder
Assessment reveals cardinal signs of dry mouth, eyes, and mucous membranes, which may be accompanied by photosensitivity, poor vision, eye fatigue, nasal crusting, and epistaxis.
Syphilis (secondary)
Generalized lymphadenopathy occurs in the second stage and may be accompanied by a macular, papular, pustular, or nodular rash on the arms, trunk, palms, soles, face, and scalp
A palmar rash is a significant diagnostic sign. A headache, malaise, anorexia, weight loss, nausea, vomiting, a sore throat, and a low-grade fever may occur.
Systemic lupus erythematosus
Generalized lymphadenopathy typically accompanies the hallmark butterfly rash, photosensitivity, Raynaud’s phenomenon, and joint pain and stiffness
Pleuritic chest pain and a cough may appear with systemic findings, such as a fever, anorexia, and weight loss.
Tuberculous lymphadenitis
Lymphadenopathy may be generalized or restricted to superficial lymph nodes
Affected lymph nodes may become fluctuant and drain to surrounding tissue. They may be accompanied by a fever, chills, weakness, and fatigue.
Waldenström’s macroglobulinemia
Lymphadenopathy may appear along with hepatosplenomegaly
Associated findings include retinal hemorrhage, pallor, and signs of heart failure, such as jugular vein distention and crackles. The patient shows a decreased level of consciousness, abnormal reflexes, and signs of peripheral neuritis. Weakness, fatigue, weight loss, epistaxis, and GI bleeding may also occur. Circulatory impairment occurs because of increased blood viscosity.
Other causes
Drugs
Phenytoin may cause generalized lymphadenopathy.
Immunizations
Typhoid vaccination may cause generalized lymphadenopathy.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Edema of the arm:
Medical causes
(Handbook of Signs & Symptoms (Third Edition))
Angioneurotic edema
Angioneurotic edema is a common reaction that's characterized by the sudden onset of painless, nonpruritic edema affecting the hands, feet, eyelids, lips, face, neck, genitalia, or viscera. Although swelling usually doesn't itch, it may burn and tingle. If edema spreads to the larynx, signs of respiratory distress may occur
Arm trauma
Shortly after a crush injury, severe edema may affect the entire arm. Ecchymoses or superficial bleeding, pain or numbness, and paralysis may occur.
Burns
Twodays or less after injury, arm burns may cause mild to severe edema, pain, and tissue damage.
Envenomation
Envenomation by snakes, aquatic animals, or insects initially may cause edema around the bite or sting that quickly spreads to the entire arm. Pain, erythema, and pruritus at the site are common; paresthesia occurs occasionally. Later, the patient may develop generalized signs and symptoms, such as nausea, vomiting, weakness, muscle cramps, a fever, chills, hypotension, a headache and, in severe cases, dyspnea, seizures, and paralysis.
Superior vena cava syndrome
Bilateral arm edema usually progresses slowly and is accompanied by facial and neck edema. Dilated veins mark these edematous areas. The patient also complains of a headache, vertigo, and vision disturbances.
Thrombophlebitis
Thrombophlebitis, which can result from peripherally inserted central catheters and arm portocaths, may cause arm edema, pain, and warmth. Deep vein thrombophlebitis can also produce cyanosis, a fever, chills, and malaise; superficial thrombophlebitis alsocauses redness, tenderness, and induration along the vein.
Other causes
Treatments
Localized arm edema may result from infiltration of I.V. fluid into the interstitial tissue. A radical or modified radical mastectomy that disrupts lymphatic drainage may cause edema of the entire arm, as can axillary lymph node dissection. Also, radiation therapy for breast cancer may produce arm edema immediately after treatment or months later.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Edema of the leg:
Medical causes
(Handbook of Signs & Symptoms (Third Edition))
Burns
Two days or less after injury, leg burns may cause mild to severe edema, pain, and tissue damage.
Cellulitis
Pitting edema and orange peel skin are caused by a streptococcal or staphylococcal infection that most commonly occurs in the lower extremities. Cellulitis is also associated with erythema, warmth, and tenderness in the infected area.
Envenomation
Mild to severe localized edema may develop suddenly at the site of a bite or sting, along with erythema, pain, urticaria, pruritus, and a burning sensation.
Heart failure
Bilateral leg edema is an early sign of right-sided heart failure. Other signs and symptoms include weight gain despite anorexia, nausea, chest tightness, hypotension, pallor, tachypnea, exertional dyspnea, orthopnea, paroxysmal nocturnal dyspnea, palpitations, a ventricular gallop, and inspiratory crackles. Pitting ankle edema, hepatomegaly, hemoptysis, and cyanosis signal more advanced heart failure.
Leg trauma
Mild to severe localized edema may form around the trauma site.
Osteomyelitis
When osteomyelitis — a bone infection — affects the lower leg, it usually produces localized, mild to moderate edema, which may spread to the adjacent joint. Edema typically follows a fever, localized tenderness, and pain that increases with leg movement.
Thrombophlebitis
Deep and superficial vein thrombosis may cause unilateral mild to moderate edema. Deep vein thrombophlebitis may be asymptomatic or may cause mild to severe pain, warmth, and cyanosis in the affected leg as well as a fever, chills, and malaise. Superficial thrombophlebitis typically causes pain, warmth, redness, tenderness, and induration along the affected vein.
Venous insufficiency (chronic)
Moderate to severe, unilateral or bilateral leg edema occurs in patients with venous insufficiency. Initially, the edema is soft and pitting; later, it becomes hard as tissues thicken. Other signs include darkened skin and painless, easily infected stasis ulcers around the ankle. Venous insufficiency generally occurs in females.
Other causes
Diagnostic tests
Venography is a rare cause of leg edema.
Coronary artery bypass surgery
Unilateral venous insufficiency may follow saphenous vein retrieval.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Pulmonary edema:
Causes
(Professional Guide to Diseases (Eighth Edition))
Pulmonary edema usually results from left-sided heart failure due to arteriosclerotic, hypertensive, cardiomyopathic, or valvular cardiac disease. In such disorders, the compromised left ventricle in unable to maintain adequate cardiac output; increased pressures are transmitted to the left atrium, pulmonary veins, and pulmonary capillary bed. This increased pulmonary capillary hydrostatic force promotes transudation of intravascular fluids into the pulmonary interstitium, decreasing lung compliance and interfering with gas exchange. Other factors that may predispose the patient to pulmonary edema include:
❑ excessive infusion of I.V. fluids
❑ decreased serum colloid osmotic pressure as a result of nephrosis, protein-losing enteropathy, extensive burns, hepatic disease, or nutritional deficiency
❑ impaired lung lymphatic drainage from Hodgkin’s disease or obliterative lymphangitis after radiation
❑ mitral stenosis, which impairs left atrial emptying
❑ pulmonary veno-occlusive disease.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Edema, generalized:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Angioneurotic edema or angioedema
Recurrent attacks of acute, painless, nonpitting edema involving the skin and mucous membranes—especially those of the respiratory tract, face, neck, lips, larynx, hands, feet, genitalia, or viscera—may be the result of a food or drug allergy or emotional stress, or they may be hereditary. Abdominal pain, nausea, vomiting, and diarrhea accompany visceral edema; dyspnea and stridor accompany life-threatening laryngeal edema.
Burns
Edema and associated tissue damage vary with the severity of the burn. Severe generalized edema (4+) may occur within 2 days of a major burn; localized edema may occur with a less severe burn.
Cirrhosis
A late sign of chronic cirrhosis, edema usually starts in the legs and thighs and may progress to anasarca. Accompanying signs and symptoms include abdominal pain, anorexia, nausea and vomiting, hepatomegaly, ascites, jaundice, pruritus, bleeding tendencies, musty breath, lethargy, mental changes, and asterixis.
Heart failure
Severe, generalized pitting edema—occasionally anasarca—may follow leg edema late in heart failure. The edema may improve with exercise or elevation of the limbs and is typically worse at the end of the day. Among other classic late findings are hemoptysis, cyanosis, marked hepatomegaly, clubbing, crackles, and a ventricular gallop. Typically, the patient has tachypnea, palpitations, hypotension, weight gain despite anorexia, nausea, slowed mental response, diaphoresis, and pallor. Dyspnea, orthopnea, tachycardia, and fatigue typify left-sided heart failure; jugular vein distention, hepatomegaly, and peripheral edema typify right-sided heart failure.
Malnutrition
Anasarca in this disorder may mask dramatic muscle wasting. Malnutrition also typically causes muscle weakness; lethargy; anorexia; diarrhea; apathy; dry, wrinkled skin; and signs of anemia, such as dizziness and pallor.
Myxedema
In this severe form of hypothyroidism, generalized nonpitting edema is accompanied by dry, flaky, inelastic, waxy, pale skin; a puffy face; and an upper eyelid droop. Observation also reveals masklike facies, hair loss or coarsening, and psychomotor slowing. Associated findings include hoarseness, weight gain, fatigue, cold intolerance, bradycardia, hypoventilation, constipation, abdominal distention, menorrhagia, impotence, and infertility.
Nephrotic syndrome
Although nephrotic syndrome is characterized by generalized pitting edema, the edema is initially localized around the eyes. Anasarca develops in severe cases, increasing body weight by up to 50%. Other common signs and symptoms are ascites, anorexia, fatigue, malaise, depression, and pallor.
Pericardial effusion
In pericardial effusion, generalized pitting edema may be most prominent in the arms and legs. It may be accompanied by chest pain, dyspnea, orthopnea, a nonproductive cough, pericardial friction rub, jugular vein distention, dysphagia, and fever.
Pericarditis (chronic constructive)
Like right-sided heart failure, this disorder usually begins with pitting edema of the arms and legs that may progress to generalized edema. Other signs and symptoms include ascites, Kussmaul’s sign, dyspnea, fatigue, weakness, abdominal distention, and hepatomegaly.
Protein-losing enteropathy
Increased albumin levels lead to progressive generalized pitting edema in this disorder. The patient may also have a mild fever and abdominal pain with bloody diarrhea and steatorrhea.
Renal failure
Generalized pitting edema is a late sign of acute renal failure. In chronic failure, edema is less likely to become generalized; its severity depends on the degree of fluid overload. Both forms of renal failure cause oliguria, anorexia, nausea and vomiting, drowsiness, confusion, hypertension, dyspnea, crackles, dizziness, and pallor.
Septic shock
A late sign of this life-threatening disorder, generalized edema typically develops rapidly. The edema is pitting and moderately severe. Accompanying it may be cool skin, hypotension, oliguria, tachycardia, cyanosis, thirst, anxiety, and signs of respiratory failure.
Other causes
Drugs
Any drug that causes sodium retention may aggravate or cause generalized edema. Examples include antihypertensives, corticosteroids, androgenic and anabolic steroids, estrogens, and nonsteroidal anti-inflammatory drugs, such as ibuprofen and naproxen.
Treatments
I.V. saline solution infusions and internal feedings may cause sodium and fluid overload, resulting in generalized edema, especially in patients with cardiac or renal disease.
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Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Lymphadenopathy:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Acquired immunodeficiency syndrome
Besides lymphadenopathy, findings include a history of fatigue, night sweats, afternoon fevers, diarrhea, weight loss, and cough with several concurrent infections appearing soon afterward.
Anthrax (cutaneous)
Lymphadenopathy, malaise, headache and fever may develop along with a lesion that progresses into a painless, necrotic-centered ulcer.
Brucellosis
Generalized lymphadenopathy usually affects cervical and axillary lymph nodes, making them tender. This disease usually begins insidiously with easy fatigability, malaise, headache, backache, anorexia, weight loss, and arthralgias; it may also begin abruptly with chills, fever that usually rises in the morning and subsides during the day, and diaphoresis.
Chronic fatigue syndrome
Lymphadenopathy may occur with incapacitating fatigue, sore throat, low-grade fevers, myalgia, cognitive dysfunction, and sleep disturbances. The diagnosis is one of exclusion and the cause of this syndrome is unknown.
Cytomegalovirus infection
Generalized lymphadenopathy occurs in the immunocompromised patient and is accompanied by fever, malaise, rash, and hepatosplenomegaly.
Hodgkin’s disease
The extent of lymphadenopathy reflects the stage of malignancy—from stage I involvement of a single lymph node region to stage IV generalized lymphadenopathy. Common early signs and symptoms include pruritus and, in older patients, fatigue, weakness, night sweats, malaise, weight loss, and unexplained fever (usually to 101° F [38.3° C]). Also, if mediastinal lymph nodes enlarge, tracheal and esophageal pressure produces dyspnea and dysphagia.
Kawasaki syndrome
Cervical lymphadenopathy is a characteristic sign of this potentially life-threatening illness. Affected individuals present with high, spiking fever, along with other diagnostic signs including erythema, bilateral conjunctival injection, and swelling in the peripheral extremities. Kawasaki syndrome isn’t contagious, however the cause remains unknown and typically affects children under age 5. Prompt detection and treatment with I.V. gamma globulin is essential in preventing serious complications, such as coronary artery dilations and aneurysms.
Leptospirosis
Lymphadenopathy occurs infrequently in this rare disease. More common findings include sudden onset of fever and chills, malaise, myalgia, headache, nausea and vomiting, and abdominal pain.
Leukemia (acute lymphocytic)
Generalized lymphadenopathy is accompanied by fatigue, malaise, pallor, and low fever. The patient also experiences prolonged bleeding time, swollen gums, weight loss, bone or joint pain, and hepatosplenomegaly.
Leukemia (chronic lymphocytic)
Generalized lymphadenopathy appears early, along with fatigue, malaise, and fever. As the disease progresses, hepatosplenomegaly, severe fatigue, and weight loss occur. Other late findings include bone tenderness, edema, pallor, dyspnea, tachycardia, palpitations, bleeding, anemia, and macular or nodular lesions.
Lyme disease
Spread by the bite of certain ticks, Lyme disease begins with a skin lesion called erythema chronicum migrans. As the disease progresses, the patient may suffer from lymphadenopathy, constant malaise and fatigue, and intermittent headache, fever, chills, and aches. He may go on to develop arthralgias and, eventually, neurologic and cardiac abnormalities.
Monkeypox
Lymphadenopathy is the one symptom that clearly distinguishes monkeypox from smallpox. Humans infected with monkeypox usually develop cervical or inguinal lymphadenopathy, along with other characteristic symptoms such as fever, chills, throat pain, muscle aches, and rash. This rare viral disease acquired its name after being discovered in laboratory monkeys; however, many other animals can carry this disease. Although the monkeypox virus is similar to smallpox, the smallpox vaccine is only used in limited circumstances to protect certain at-risk individuals against the disease.
Mononucleosis (infectious)
Characteristic, painful lymphadenopathy involves cervical, axillary, and inguinal nodes. Posterior cervical adenopathy is also common. Prodromal symptoms, such as malaise, fatigue, and headache, typically occur 3 to 5 days before the appearance of the classic triad of lymphadenopathy, sore throat, and temperature fluctuations with an evening peak of about 102° F (38.9° C). Hepatosplenomegaly may develop, along with findings of stomatitis, exudative tonsillitis, or pharyngitis.
Mycosis fungoides
Lymphadenopathy occurs in stage III of this rare, chronic malignant lymphoma and is accompanied by ulcerated brownish red tumors that are painful and itchy.
Non-Hodgkin’s lymphoma
Painless enlargement of one or more peripheral lymph nodes is the most common sign of this disease, with generalized lymphadenopathy characterizing stage IV. Dyspnea, cough, and hepatosplenomegaly occur, along with systemic complaints of fever to 101° F (38.3° C), night sweats, fatigue, malaise, and weight loss.
Plague
(Yersinia pestis). Signs and symptoms of the bubonic form of this bacterial infection include lymphadenopathy, fever, and chills.
Rheumatoid arthritis
Lymphadenopathy is an early, nonspecific finding associated with fatigue, malaise, continuous low fever, weight loss, and vague arthralgias and myalgias. Later, the patient develops joint tenderness, swelling, and warmth; joint stiffness after inactivity (especially in the morning); and subcutaneous nodules on the elbows. Eventually joint deformity, muscle weakness, and atrophy may occur.
Sarcoidosis
Generalized, bilateral hilar and right paratracheal forms of lymphadenopathy (seen on chest X-ray) with splenomegaly are common. Initial findings are arthralgia, fatigue, malaise, weight loss, and pulmonary symptoms. Other findings vary with the site and extent of fibrosis. Typical cardiopulmonary findings include breathlessness, cough, substernal chest pain, and arrhythmias. About 90% of patients have an abnormal chest X-ray at sometime during their illness. Musculoskeletal and cutaneous features may include muscle weakness and pain, phalangeal and nasal mucosal lesions, and subcutaneous skin nodules. Common ophthalmic findings include eye pain, photophobia, and nonreactive pupils. Central nervous system involvement may produce cranial or peripheral nerve palsies and seizures.
Sjögren’s syndrome
Lymphadenopathy of the parotid and submaxillary nodes may occur in this rare disorder. Assessment reveals cardinal signs of dry mouth, eyes, and mucous membranes, which may be accompanied by photosensitivity, poor vision, eye fatigue, nasal crusting, and epistaxis.
Syphilis (primary)
Localized lymphadenopathy and a painless ulcer (canker) with an indurated border and relatively smooth base at the site of sexual exposure characterize this infection. The ulcer is usually single but more than one may be present.
Syphilis (secondary)
Generalized lymphadenopathy occurs in the second stage and may be accompanied by a macular, papular, pustular, or nodular rash on the arms, trunk, palms, soles, face, and scalp. A palmar rash is a significant diagnostic sign. Headache, malaise, anorexia, weight loss, nausea, vomiting, sore throat, and low fever may occur.
Systemic lupus erythematosus
Generalized lymphadenopathy typically accompanies the hallmark butterfly rash, photosensitivity, Raynaud’s phenomenon, and joint pain and stiffness. Pleuritic chest pain and cough may appear with systemic findings, such as fever, anorexia, and weight loss.
Tuberculous lymphadenitis
Lymphadenopathy may be generalized or restricted to superficial lymph nodes. Affected lymph nodes may become fluctuant and drain to surrounding tissue. They may be accompanied by fever, chills, weakness, and fatigue.
Waldenström’s macroglobulinemia
Lymphadenopathy may appear along with hepatosplenomegaly. Associated findings include retinal hemorrhage, pallor, and signs of heart failure, such as jugular vein distention and crackles. The patient shows decreased level of consciousness, abnormal reflexes, and signs of peripheral neuritis. Weakness, fatigue, weight loss, epistaxis, and GI bleeding may also occur. Circulatory impairment occurs because of an increased viscosity of the blood.
Other causes
Drugs
Phenytoin may cause generalized lymphadenopathy.
Immunizations
Typhoid vaccination may cause generalized lymphadenopathy.
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Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Edema of the arm:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Angioneurotic edema
Angioneurotic edema is a common reaction that’s characterized by sudden onset of painless, nonpruritic edema in the hands, feet, eyelids, lips, face, neck, genitalia, or viscera. Although these swellings usually don’t itch, they may burn and tingle. If edema spreads to the larynx, signs of respiratory distress may occur.
Arm trauma
Shortly after a crush injury, severe edema may affect the entire arm. It may be accompanied by ecchymoses or superficial bleeding, pain or numbness, and paralysis.
Burns
Mild to severe edema, pain, and tissue damage may occur up to 2 days after an arm burn.
Superior vena cava syndrome
Bilateral arm edema usually progresses slowly in this disorder and is accompanied by facial and neck edema. Dilated veins mark these edematous areas. The patient also complains of headache, vertigo, and vision disturbances.
Thrombophlebitis
Thrombophlebitis, which can result from peripherally inserted central catheters or arm portacaths, may cause arm edema, pain, and warmth. Deep vein thrombophlebitis can also produce cyanosis, fever, chills, and malaise; superficial thrombophlebitis also causes redness, tenderness, and induration along the vein.
Other causes
Envenomation
Envenomation by snakes, aquatic animals, or insects initially may cause edema around the bite or sting that quickly spreads to the entire arm. Pain, erythema, and pruritus at the site are common; paresthesia occurs occasionally. Later, the patient may develop generalized signs and symptoms, such as nausea, vomiting, weakness, muscle cramps, fever, chills, hypotension, headache and, in severe cases, dyspnea, seizures, and paralysis.
Treatments
Localized arm edema may result from infiltration of I.V. fluid into the interstitial tissue. A radical or modified radical mastectomy that disrupts lymphatic drainage may cause edema of the entire arm, as can axillary lymph node dissection. Also, radiation therapy for breast cancer may produce arm edema immediately after treatment or months later.
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Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Edema of the face:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Abscess, periodontal
This type of abscess, which usually results from poor oral hygiene, is commonly caused by anaerobic organisms. It can cause edema of the side of the face, pain, warmth, erythema, and a purulent discharge around the affected tooth.
Abscess, peritonsillar
This complication of tonsillitis may cause unilateral facial edema. Other key signs and symptoms include severe throat pain, neck swelling, drooling, cervical adenopathy, fever, chills, and malaise.
Allergic reaction
Facial edema may characterize both a local allergic reaction and anaphylaxis. A local reaction produces facial edema, erythema, and urticaria. In life-threatening anaphylaxis, angioneurotic facial edema may occur with urticaria and flushing. (See Recognizing angioneurotic edema.) Airway edema causes hoarseness, stridor, and bronchospasm with dyspnea and tachypnea. Signs of shock, such as hypotension and cool, clammy skin, may also occur.
Cavernous sinus thrombosis
Cavernous sinus thrombosis is a rare but serious disorder that may begin with unilateral edema that quickly progresses to bilateral edema of the forehead, base of the nose, and eyelids. It may also produce chills, fever, headache, nausea, lethargy, exophthalmos, and eye pain.
Chalazion
A chalazion causes localized swelling and tenderness of the affected eyelid, accompanied by a small red lump on the conjunctival surface.
Conjunctivitis
Conjunctivitis is an inflammation that causes eyelid edema, excessive tearing, and itchy, burning eyes. Inspection reveals a thick purulent discharge, crusty eyelids, and conjunctival injection. Corneal involvement causes photophobia and pain.
Corneal ulcers, fungal
Accompanying red, edematous eyelids in this disorder are conjunctival injection, intense pain, photophobia, and severely impaired visual acuity. Copious amounts of a purulent eye discharge make the eyelids sticky and crusted. The characteristic dense, central ulcer grows slowly, is whitish gray, and is surrounded by progressively clearer rings.
Dacryoadenitis
Severe periorbital swelling characterizes dacryoadenitis, which may also cause conjunctival injection, a purulent discharge, and temporal pain.
Dacryocystitis
Lacrimal sac inflammation causes prominent eyelid edema and constant tearing. In acute cases, pain and tenderness near the tear sac accompany a purulent discharge.
Dermatomyositis
Periorbital edema and a heliotropic rash develop gradually in this rare disease. An itchy, lilac-colored rash appears on the bridge of the nose, cheeks, and forehead. Localized or diffuse erythema, eye pain, and fever may also occur.
Facial burns
Burns may cause extensive edema that impairs respiration. Additional findings include singed nasal hairs, red mucosa, sooty sputum, and signs of respiratory distress such as inspiratory stridor.
Facial trauma
The extent of edema varies with the type of injury. For example, a contusion may cause localized edema, whereas a nasal or maxillary fracture causes more generalized edema. Associated features also depend on the type of injury.
Frontal sinus cancer
This rare form of cancer causes cheek edema on the affected side, reddened skin over the sinus, unilateral nasal bleeding or discharge, and exophthalmos. Pain over the forehead and unilateral hypoesthesia or anesthesia may occur later.
Herpes zoster ophthalmicus (shingles)
In herpes zoster ophthalmicus, edematous and red eyelids are usually accompanied by excessive tearing and a serous discharge. Severe unilateral facial pain may occur several days before vesicles erupt.
Hordeolum (stye)
Typically, a hordeolum produces localized eyelid edema, erythema, and pain.
Malnutrition
Severe malnutrition causes facial edema followed by swelling of the feet and legs. Associated signs and symptoms include muscle atrophy and weakness; anorexia; diarrhea; lethargy; dry, wrinkled skin; sparse, brittle, easily plucked hair; and decreased pulse and respiratory rates.
Melkersson’s syndrome
Facial edema (especially of the lips), facial paralysis, and folds in the tongue are the three characteristic signs of this rare disorder.
Myxedema
Myxedema eventually causes generalized facial edema, waxy dry skin, hair loss or coarsening, and other signs of hypothyroidism.
Nephrotic syndrome
Commonly the first sign of nephrotic syndrome, periorbital edema precedes dependent and abdominal edema. Associated findings include weight gain, nausea, anorexia, lethargy, fatigue, and pallor.
Orbital cellulitis
Sudden onset of periorbital edema marks this inflammatory disorder. It may be accompanied by a unilateral purulent discharge, hyperemia, exophthalmos, conjunctival injection, impaired extraocular movements, fever, and extreme orbital pain.
Osteomyelitis
When osteomyelitis affects the frontal bone, it may cause forehead edema as well as fever, chills, headache, and cool, pallid skin.
Preeclampsia
Edema of the face, hands, and ankles is an early sign of this disorder of pregnancy. Other characteristics include excessive weight gain, severe headache, blurred vision, hypertension, and midepigastric pain.
Rhinitis, allergic
In allergic rhinitis, red and edematous eyelids are accompanied by paroxysmal sneezing, itchy nose and eyes, and profuse, watery rhinorrhea. The patient may also develop nasal congestion, excessive tearing, headache, sinus pain, and sometimes malaise and fever.
Sinusitis
Frontal sinusitis causes edema of the forehead and eyelids. Maxillary sinusitis produces edema in the maxillary area as well as malaise, gingival swelling, and trismus. Both types are also accompanied by facial pain, fever, nasal congestion, a purulent nasal discharge, and red, swollen nasal mucosa.
Superior vena cava syndrome
Superior vena cava syndrome gradually produces facial and neck edema accompanied by thoracic or jugular vein distention. It also causes central nervous system symptoms, such as headache, vision disturbances, and vertigo.
Trachoma
In trachoma, edema affects the eyelid and conjunctiva and is accompanied by eye pain, excessive tearing, photophobia, and eye discharge. Examination reveals an inflamed preauricular node and visible conjunctival follicles.
Trichinosis
This relatively rare infectious disorder causes sudden onset of eyelid edema with fever (102° F to l04° F [38.9° C to 40° C]), conjunctivitis, muscle pain, itching and burning skin, sweating, skin lesions, and delirium.
Other causes
Diagnostic tests
An allergic reaction to contrast media used in radiologic tests may produce facial edema.
Drugs
Long-term use of glucocorticoids may produce facial edema. Any drug that causes an allergic reaction (aspirin, antipyretics, penicillin, and sulfa preparations, for example) may have the same effect.
Herb Alert
Ingestion of the fruit pulp of ginkgo biloba can cause severe erythema and edema and the rapid formation of vesicles. Feverfew and chrysanthemum parthenium can cause swelling of the lips, irritation of the tongue, and mouth ulcers. Licorice may cause facial edema and water retention or bloating, especially if used before menses.
Surgery and transfusion
Facial edema may result from cranial, nasal, or jaw surgery or from a blood transfusion that causes an allergic reaction.
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Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Edema of the leg:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Burns
Mild to severe edema, pain, and tissue damage may occur up to 2 days after a leg burn.
Cellulitis
Caused by a streptococcal or staphylococcal infection that usually affects the legs, cellulitis produces pitting edema and orange peel skin along with erythema, warmth, and tenderness in the infected area.
Cirrhosis
Cirrhosis commonly causes bilateral edema, which is associated with ascites, jaundice, and abdominal swelling.
Heart failure
Bilateral leg edema is an early sign of right-sided heart failure. Other signs and symptoms include weight gain despite anorexia, nausea, chest tightness, hypotension, pallor, tachypnea, exertional dyspnea, orthopnea, paroxysmal nocturnal dyspnea, palpitations, a ventricular gallop, and inspiratory crackles. Pitting ankle edema, hepatomegaly, hemoptysis, and cyanosis signal more advanced heart failure.
Hypoproteinemia
Malnourished patients may develop bilateral leg edema secondary to decreased protein and osmotic pressures.
Leg trauma
Mild to severe localized edema may form around the trauma site.
Nephrotic syndrome
Nephrotic syndrome is commonly seen in children and results in bilateral leg edema. It’s associated with polyuria and eyelid swelling.
Osteomyelitis
When this bone infection affects the lower leg, it usually produces localized, mild to moderate edema, which may spread to the adjacent joint. Edema typically follows fever, localized tenderness, and pain that increases with leg movement.
Phlegmasia cerulea dolens
Severe unilateral leg edema and cyanosis may spread to the abdomen and flank in this rare form of venous thrombosis. Other signs and symptoms include pain, cold skin, absent pulse in the affected leg, and signs of shock, such as hypotension and tachycardia.
Rupture of the gastrocnemius muscle
Ruptured gastrocnemius muscle can cause leg edema and often occurs in runners. Pain is usually sudden, and ecchymosis is evident on the ankles.
Rupture of a popliteal (Baker’s) cyst
A ruptured popliteal cyst can cause sudden onset of unilateral calf pain and edema, usually after walking or exercising. This type of cyst is common in patients with arthritis. It can compress vascular structures and cause severe edema and thrombophlebitis.
Thrombophlebitis
Both deep and superficial vein thrombosis may cause unilateral mild to moderate edema. Deep vein thrombophlebitis may be asymptomatic or may cause mild to severe pain, warmth, and cyanosis in the affected leg as well as fever, chills, and malaise. Superficial vein thrombophlebitis typically causes pain, warmth, redness, tenderness, and induration along the affected vein.
Venous insufficiency (chronic)
Moderate to severe unilateral or bilateral leg edema occurs in patients with this disorder, which generally affects females. Initially soft and pitting, the edema later becomes hard as tissues thicken. Other signs include darkened skin and painless, easily infected stasis ulcers around the ankle.
Other causes
Coronary artery bypass surgery
Unilateral venous insufficiency may follow saphenous vein retrieval. Edema often occurs in the affected leg or ankle and usually resolves after 6 to 8 weeks.
Diagnostic tests
Venography is a rare cause of leg edema.
Drugs
Estrogen, hormonal contraceptives, lithium, nonsteroidal anti-inflammatory drugs, vasodilators, and drugs that cause sodium retention can cause bilateral leg edema.
Envenomation
Mild to severe localized edema may develop suddenly at the site of a bite or sting along with erythema, pain, urticaria, pruritus, and a burning sensation.
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Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Edema:
Differential Overview
(Field Guide to Bedside Diagnosis)
❑ Congestive heart failure
❑ Venous insufficiency
❑ Hypoalbuminemia
❑ Drugs
❑ Cirrhosis
❑ Deep vein thrombosis
❑ Inferior vena cava obstruction
❑ Lymphatic obstruction
❑ Glomerular injury
❑ Idiopathic edema
❑ Myxedema
❑ Lipedema
❑ Toxemia
❑ Cyclical edema
❑ Refeeding
❑ Filariasis
❑ Milroy
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Source: Field Guide to Bedside Diagnosis, 2007
Lymphadenopathy:
Differential Overview
(Field Guide to Bedside Diagnosis)
Generalized
❑ Infectious mononucleosis
❑ Drugs
❑ Connective tissue disease
❑ HIV infection
❑ Sarcoidosis
❑ Serum sickness
❑ Toxoplasmosis
❑ Secondary syphilis
Localized
❑ Regional infection
❑ Lymphadenitis
❑ Hodgkin lymphoma
❑ Cat-scratch disease
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Source: Field Guide to Bedside Diagnosis, 2007
Pulmonary edema:
Causes
(Handbook of Diseases)
Pulmonary edema usually results from left-sided heart failure due to arteriosclerotic, hypertensive, cardiomyopathic, or valvular heart disease. In such disorders, the compromised left ventricle requires increased filling pressures to maintain adequate output; these pressures are transmitted to the left atrium, pulmonary veins, and pulmonary capillary bed.
This increased pulmonary capillary hydrostatic force promotes transudation of intravascular fluids into the pulmonary interstitium, decreasing lung compliance and interfering with gas exchange. Other factors that may predispose a person to pulmonary edema include:
❑ infusion of excessive volumes of I.V. fluids
❑ decreased serum colloid osmotic pressure as a result of nephrosis, extensive burns, hepatic disease, or nutritional deficiency
❑ impaired lung lymphatic drainage from Hodgkin’s disease or obliterative lymphangitis after radiation
❑ mitral stenosis and left atrial myxoma, which impair left atrial emptying
❑ pulmonary veno-occlusive disease.
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Source: Handbook of Diseases, 2003
Edema, generalized:
Medical causes
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
Angioneurotic edema or angioedema
Recurrent attacks of acute, painless, nonpitting edema involving the skin and mucous membranes — especially those of the respiratory tract, face, neck, lips, larynx, hands, feet, genitalia, or viscera — may be the result of a food or drug allergy or emotional stress, or they may be hereditary. Abdominal pain, nausea, vomiting, and diarrhea accompany visceral edema; dyspnea and stridor accompany life-threatening laryngeal edema.
Burns
Edema and associated tissue damage vary with the severity of the burn. Severe generalized edema (4+) may occur within 2 days of a major burn; localized edema may occur with a less severe burn.
Cirrhosis
Edema that usually starts in the legs and thighs and may progress to the degree of anasarca. Edema is a late sign of cirrhosis — a chronic disease. Accompanying signs and symptoms include abdominal pain, anorexia, nausea and vomiting, hepatomegaly, ascites, jaundice, pruritus, bleeding tendencies, musty breath, lethargy, mental changes, and asterixis.
Heart failure
Severe, generalized pitting edema — occasionally anasarca — may follow leg edema late in heart failure. Edema may improve with exercise or elevation of the limbs and is typically worse at the end of the day. Among other classic late findings are hemoptysis, cyanosis, marked hepatomegaly, clubbing, crackles, and a ventricular gallop. Typically, the patient has tachypnea, palpitations, hypotension, weight gain despite anorexia, nausea, slowed mental response, diaphoresis, and pallor. Dyspnea, orthopnea, tachycardia, and fatigue typify left-sided heart failure; jugular vein distention, enlarged liver, and peripheral edema typify right-sided heart failure.
Malnutrition
Anasarca in malnutrition may mask dramatic muscle wasting. Malnutrition also typically causes muscle weakness; lethargy; anorexia; diarrhea; apathy; dry, wrinkled skin; and signs of anemia, such as dizziness and pallor.
Myxedema
With myxedema — the severe form of hypothyroidism — generalized nonpitting edema is accompanied by dry, flaky, inelastic, waxy, pale skin, a puffy face, and an upper eyelid droop. Assessment also reveals masklike facies, hair loss or coarsening, and psychomotor slowing. Associated findings include hoarseness, weight gain, fatigue, cold intolerance, bradycardia, hypoventilation, constipation, abdominal distention, menorrhagia, impotence, and infertility.
Nephrotic syndrome
Although nephrotic syndrome is characterized by generalized pitting edema, the edema is initially localized around the eyes. With severe cases, anasarca develops, increasing body weight by up to 50%. Other common signs and symptoms are ascites, anorexia, fatigue, malaise, depression, and pallor.
Pericardial effusion
With pericardial effusion, generalized pitting edema may be most prominent in the arms and legs. It may be accompanied by chest pain, dyspnea, orthopnea, nonproductive cough, pericardial friction rub, jugular vein distention, dysphagia, and fever.
Pericarditis (chronic constructive)
Resembling right-sided heart failure, pericarditis usually begins with pitting edema of the arms and legs that may progress to generalized edema. Other signs and symptoms include ascites, Kussmaul’s sign, dyspnea, fatigue, weakness, abdominal distention, and hepatomegaly.
Protein-losing enteropathy
Increased albumin levels lead to progressive generalized pitting edema in protein-losing enteropathy. The patient may also have mild fever and abdominal pain with bloody diarrhea and steatorrhea.
Renal failure
With acute renal failure, generalized pitting edema occurs as a late sign. With chronic failure, edema is less likely to become generalized; its severity depends on the degree of fluid overload. Both forms of renal failure cause oliguria, anorexia, nausea and vomiting, drowsiness, confusion, hypertension, dyspnea, crackles, dizziness, and pallor.
Septic shock
A late sign of septic shock — a life-threatening disorder — generalized edema typically develops rapidly. The edema is pitting and moderately severe. Accompanying it may be cool skin, hypotension, oliguria, tachycardia, cyanosis, thirst, anxiety, and signs of respiratory failure.
Other causes
Drugs
Any drug that causes sodium retention may aggravate or cause generalized edema. Examples include antihypertensives, corticosteroids, androgenic and anabolic steroids, estrogens, and nonsteroidal anti-inflammatories, such as celecoxib, ibuprofen, and naproxen.
Medical treatments
I.V. saline solution infusions and internal feedings may cause sodium and fluid overload, resulting in generalized edema, especially in patients with cardiac or renal disease.
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Source: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, 2007
Edema, facial:
Medical causes
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
Abscess (periodontal)
Periodontal abscess is an infection that usually results from poor oral hygiene and is commonly caused by anaerobic organisms. It can cause edema of the side of the face, pain, warmth, erythema, and purulent discharge around the affected tooth.
Abscess (peritonsillar)
Peritonsillar abscess is a complication of tonsillitis that may cause unilateral facial edema. Other key signs and symptoms include severe throat pain, neck swelling, drooling, cervical adenopathy, fever, chills, and malaise.
Allergic reaction
Facial edema may characterize both local allergic reactions and anaphylaxis. With life-threatening anaphylaxis,
angioneurotic facial edema may occur with urticaria and flushing. (See
Recognizing angioneurotic edema, page 129.) Airway edema causes hoarseness, stridor, and bronchospasm with dyspnea and tachypnea. Signs of shock, such as hypotension and cool, clammy skin, may also occur. A localized reaction produces facial edema, erythema, and urticaria.
Cavernous sinus thrombosis
Cavernous sinus thrombosis is a rare but serious disorder that may begin with unilateral edema that quickly progresses to bilateral edema of the forehead, base of the nose, and eyelids. It may also produce chills, fever, headache, nausea, lethargy, exophthalmos, and eye pain.
Chalazion
A chalazion causes localized swelling and tenderness of the affected eyelid, accompanied by a small red lump on the conjunctival surface.
Conjunctivitis
Conjunctivitis causes eyelid edema, excessive tearing, and itchy, burning eyes. Inspection reveals a thick purulent discharge, crusty eyelids, and conjunctival injection. Corneal involvement causes photophobia and pain.
Corneal ulcers (fungal)
Accompanying red, edematous eyelids in corneal ulcers are conjunctival injection, intense pain, photophobia, and severely impaired visual acuity. Copious, purulent eye discharge makes eyelids sticky and crusted. The characteristic dense, central ulcer grows slowly, is whitish gray, and is surrounded by progressively clearer rings.
Dacryoadenitis
Severe periorbital swelling characterizes dacryoadenitis, which may also cause conjunctival injection, purulent discharge, and temporal pain.
Dacryocystitis
Lacrimal sac inflammation causes prominent eyelid edema and constant tearing. With acute cases, pain and tenderness near the lacrimal sac accompany purulent discharge.
Dermatomyositis
Periorbital edema and heliotropic rash develop gradually in dermatomyositis — a rare disease. An itchy, lilac-colored rash appears on the bridge of the nose, cheeks, and forehead. Localized or diffuse erythema, eye pain, and fever may also occur.
Facial burns
Burns may cause extensive edema that impairs respiration. Additional findings include singed nasal hairs, red mucosa, sooty sputum, and signs of respiratory distress, such as inspiratory stridor.
Facial trauma
The extent of edema varies with the type of injury. For example, a contusion may cause localized edema, whereas a nasal or maxillary fracture causes more generalized edema. Associated symptoms also depend on the type of injury.
Frontal sinus cancer
Frontal sinus cancer is a rare form of cancer that causes cheek edema on the affected side, reddened skin over the sinus, unilateral nasal bleeding or discharge, and exophthalmos. Pain over the forehead and unilateral hypoesthesia or anesthesia may occur later.
Herpes zoster ophthalmicus (shingles)
With herpes zoster ophthalmicus, edematous and red eyelids are usually accompanied by excessive tearing and a serous discharge. Severe unilateral facial pain may occur several days before vesicles erupt.
Hordeolum (stye)
Typically, localized eyelid edema, erythema, and pain occur with a hordeolum.
Malnutrition
Severe malnutrition causes facial edema followed by swelling of the feet and legs. Associated signs and symptoms include muscle atrophy and weakness; anorexia; diarrhea; lethargy; dry, wrinkled skin; sparse, brittle, easily plucked hair; and slowed pulse and respiratory rates.
Melkersson’s syndrome
Facial edema (especially of the lips), facial paralysis, and folds in the tongue are the three characteristic signs of Melkersson’s syndrome.
Myxedema
Myxedema eventually causes generalized facial edema, waxy dry skin, hair loss or coarsening, and other signs of hypothyroidism.
Nephrotic syndrome
Commonly the first sign of nephrotic syndrome, periorbital edema precedes dependent and abdominal edema. Associated findings include weight gain, nausea, anorexia, lethargy, fatigue, and pallor.
Orbital cellulitis
Sudden onset of periorbital edema marks orbital cellulitis. It may be accompanied by a unilateral purulent discharge, hyperemia, exophthalmos, conjunctival injection, impaired extraocular movements, fever, and extreme orbital pain.
Osteomyelitis
When osteomyelitis affects the frontal bone, it may cause forehead edema as well as fever, chills, headache, and cool, pallid skin.
Preeclampsia
Edema of the face, hands, and ankles is an early sign of preeclampsia — a disorder of pregnancy. Other characteristics include excessive weight gain, severe headache, blurred vision, hypertension, and midepigastric pain.
Rhinitis (allergic)
With rhinitis, red and edematous eyelids are accompanied by paroxysmal sneezing, itchy nose and eyes, and profuse, watery rhinorrhea. The patient may also develop nasal congestion, excessive tearing, headache, sinus pain, and sometimes malaise and fever.
Sinusitis
Frontal sinusitis causes edema of the forehead and eyelids. Maxillary sinusitis produces edema in the maxillary area as well as malaise, gingival swelling, and trismus. Both types are also accompanied by facial pain, fever, nasal congestion, purulent nasal discharge, and red, swollen nasal mucosa.
Superior vena cava syndrome
Superior vena cava syndrome gradually produces facial and neck edema accompanied by thoracic or jugular vein distention. It also causes central nervous system symptoms, such as headache, vision disturbances, and vertigo.
Trachoma
With trachoma, edema affects the eyelid and conjunctiva and is accompanied by eye pain, excessive tearing, photophobia, and eye discharge. Examination reveals an inflamed preauricular node and visible conjunctival follicles.
Trichinosis
Trichinosis is a relatively rare infectious disorder that causes sudden onset of eyelid edema with fever (102° to l04° F [38.9°to 40° C]), conjunctivitis, muscle pain, itching and burning skin, sweating, skin lesions, and delirium.
Other causes
Diagnostic tests
An allergic reaction to contrast media used in radiologic tests may produce facial edema.
Drugs
Long-term use of glucocorticoids may produce facial edema. Any drug that causes an allergic reaction (aspirin, antipyretics, penicillin, and sulfa preparations, for example) may have the same effect.
Herbal remedies
Ingestion of the fruit pulp of ginkgo biloba can cause severe erythema and edema and the rapid formation of vesicles. Feverfew and chrysanthemum parthenium can cause swelling of the lips, irritation of the tongue, and mouth ulcers. Licorice may cause facial edema and water retention or bloating, especially if used before menses.
Surgery and transfusion
Cranial, nasal, or jaw surgery may cause facial edema, as may a blood transfusion that causes an allergic reaction.
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Source: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, 2007
Edema, generalized:
Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Angioneurotic edema or angioedema
Recurrent attacks of acute, painless, nonpitting edema involving the skin and mucous membranes — especially those of the respiratory tract, face, neck, lips, larynx, hands, feet, genitalia, or viscera — may be the result of a food or drug allergy or emotional stress; they may also be hereditary. Abdominal pain, nausea, vomiting, and diarrhea accompany visceral edema; dyspnea and stridor accompany life-threatening laryngeal edema.
Burns
Edema and associated tissue damage vary with the severity of the burn. Severe generalized edema (4+) may occur within 2 days of a major burn; localized edema may occur with a less severe burn. Depending on the degree of edema, the patient may experience signs and symptoms of reduced or absent circulation and airway obstruction.
Cirrhosis
Edema is a late sign of cirrhosis, a chronic disease. Accompanying signs and symptoms include abdominal pain, anorexia, nausea and vomiting, hepatomegaly, ascites, jaundice, pruritus, bleeding tendencies, musty breath, lethargy, mental changes, and asterixis.
Heart failure
Severe, generalized pitting edema — occasionally anasarca — may follow leg edema late in a patient with heart failure. The edema may improve with exercise or elevation of the limbs and tends to be worse at the end of the day. Other classic late findings include hemoptysis, cyanosis, marked hepatomegaly, clubbing, crackles, and a ventricular gallop. Typically, the patient also experiences tachypnea, palpitations, hypotension, weight gain despite anorexia, nausea, slowed mental response, diaphoresis, and pallor. Dyspnea, orthopnea, tachycardia, and fatigue signal left-sided heart failure; jugular vein distention, enlarged liver, and peripheral edema signal right-sided heart failure.
Myxedema
With myxedema, a severe form of hypothyroidism, generalized nonpitting edema is accompanied by dry, flaky, inelastic, waxy, pale skin; a puffy face; and an upper eyelid droop. Observation also reveals masklike facies, hair loss or coarsening, and psychomotor slowing. Associated findings include hoarseness, weight gain, fatigue, cold intolerance, bradycardia, hypoventilation, constipation, abdominal distention, menorrhagia, impotence, and infertility.
Nephrotic syndrome
Although nephrotic syndrome is characterized by generalized pitting edema, the edema is initially localized around the eyes. With severe cases, anasarca develops, increasing body weight by up to 50%. Other common signs and symptoms are ascites, anorexia, fatigue, malaise, depression, and pallor.
Pericardial effusion
With pericardial effusion, generalized pitting edema may be most prominent in the arms and legs. It may be accompanied by chest pain, dyspnea, orthopnea, nonproductive cough, pericardial friction rub, jugular vein distention, dysphagia, and fever.
Renal failure
Generalized pitting edema occurs as a late sign of acute renal failure. With chronic renal failure, edema is less likely to become generalized; its severity depends on the degree of fluid overload. Both forms of renal failure cause oliguria, anorexia, nausea and vomiting, drowsiness, confusion, hypertension, dyspnea, crackles, dizziness, and pallor.
Other causes
Drugs
Any drug that causes sodium retention may aggravate or cause generalized edema. Examples include antihypertensives, corticosteroids, androgenic and anabolic steroids, estrogens, and nonsteroidal anti-inflammatory drugs, such as phenylbutazone, ibuprofen, and naproxen.
Treatments
I.V. saline solution infusions and enteral feedings may cause sodium and fluid overload, resulting in generalized edema, especially in patients with cardiac or renal disease.
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Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Lymphadenopathy:
Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Acquired immunodeficiency syndrome
Besides lymphadenopathy, acquired immunodeficiency syndrome (AIDS) findings include a history of fatigue, night sweats, afternoon fevers, diarrhea, weight loss, and cough with several concurrent infections appearing soon afterward.
Anthrax (cutaneous)
With cutaneous anthrax, lymphadenopathy, malaise, headache, and fever may develop along with a small, elevated, itchy lesion resembling an insect bite that progresses into a painless, necrotic-centered ulcer.
Chronic fatigue syndrome
Lymphadenopathy may occur with incapacitating fatigue, sore throat, low-grade fevers, myalgia, cognitive dysfunction, and sleep disturbances. The patient may also experience arthralgia with arthritis, headache, and memory deficits.
Cytomegalovirus infection
Generalized lymphadenopathy is accompanied by fever, malaise, and hepato-splenomegaly in a patient infected with cytomegalovirus. The patient also develops a pruritic rash of small, erythematous macules that progresses to papules and then to vesicles.
Hodgkin’s disease
In Hodgkin’s disease, the extent of lymphadenopathy reflects the stage of malignancy, from stage I involvement of a single lymph node region to stage IV — generalized lymphadenopathy. Common early signs and symptoms include pruritus and, in older patients, fatigue, weakness, night sweats, malaise, weight loss, and unexplained fever (usually to 101° F [38.3° C]). Also, if mediastinal lymph nodes enlarge, tracheal and esophageal pressure produces dyspnea and dysphagia.
Leukemia
In acute lymphocytic leukemia, generalized lymphadenopathy is accompanied by fatigue, malaise, pallor, and low fever. The patient also experiences prolonged bleeding time, swollen gums, weight loss, bone or joint pain, and hepatosplenomegaly.
In chronic lymphocytic leukemia, generalized lymphadenopathy appears early, along with fatigue, malaise, and fever. As the disease progresses, hepatosplenomegaly, severe fatigue, and weight loss occur. Other late findings include bone tenderness, edema, pallor, dyspnea, tachycardia, palpitations, bleeding, anemia, and macular or nodular lesions.
Lyme disease
Spread by the bite of certain ticks, Lyme disease begins with a skin lesion called erythema chronicum migrans. As the disease progresses, the patient may suffer from lymphadenopathy, constant malaise and fatigue, and intermittent headache, fever, chills, and aches. He may go on to develop arthralgia and, eventually, neurologic and cardiac abnormalities.
Mononucleosis (infectious)
Patients with mononucleosis develop painful lymphadenopathy that involves the cervical, axillary, and inguinal nodes. Posterior cervical adenopathy is also common. Typically, prodromal symptoms — such as headache, malaise, and fatigue — occur 3 to 5 days before the appearance of the classic triad of lymphadenopathy, sore throat, and temperature fluctuations with an evening peak of about 102° F (38.9° C). Hepatosplenomegaly may develop, along with findings of stomatitis, exudative tonsillitis, or pharyngitis.
Non-Hodgkin’s lymphoma
Painless enlargement of one or more peripheral lymph nodes is the most common sign of non-Hodgkin’s lymphoma, with generalized lymphadenopathy characterizing stage IV. Dyspnea, cough, and hepatosplenomegaly occur, along with systemic complaints of fever to 101° F (38.3° C), night sweats, fatigue, malaise, and weight loss.
Rheumatoid arthritis
Lymphadenopathy is an early, nonspecific finding of rheumatoid arthritis that’s associated with fatigue, malaise, continuous low fever, weight loss, and vague arthralgia and myalgia. Later, the patient develops joint tenderness, swelling, and warmth; joint stiffness after inactivity (especially in the morning); and subcutaneous nodules on the elbows. Eventually joint deformity, muscle weakness, and atrophy may occur.
Sarcoidosis
Generalized, bilateral hilar and right paratracheal forms of lymphadenopathy (seen on chest X-ray) with splenomegaly are common in sarcoidosis. Initial findings are arthralgia, fatigue, malaise, weight loss, and pulmonary symptoms. Other findings vary with the site and extent of fibrosis. Typical cardiopulmonary findings include breathlessness, cough, substernal chest pain, and arrhythmias. Musculoskeletal and cutaneous features may include muscle weakness and pain, phalangeal and nasal mucosal lesions, and subcutaneous skin nodules. Common ophthalmic findings include eye pain, photophobia, and nonreactive pupils. Central nervous system involvement may produce cranial or peripheral nerve palsies and seizures.
Syphilis
Localized lymphadenopathy and a painless ulcer (canker) with an indurated border and relatively smooth base at the site of sexual exposure characterize a primary syphilis infection. The ulcer is usually single, but more than one may be present. In the second stage of syphilis, generalized lymphadenopathy occurs and may be accompanied by a macular, papular, pustular, or nodular rash on the arms, trunk, palms, soles, face, and scalp. A palmar rash is a significant diagnostic sign. Headache, malaise, anorexia, weight loss, nausea, vomiting, sore throat, and low fever may occur.
Systemic lupus erythematosus
Generalized lymphadenopathy typically accompanies the hallmark butterfly rash, photosensitivity, Raynaud’s phenomenon, and joint pain and stiffness associated with systemic lupus erythematosus (SLE). Pleuritic chest pain and cough may appear with systemic findings, such as fever, anorexia, and weight loss.
Tuberculous lymphadenitis
With tuberculous lymphadenitis, lymphadenopathy may be generalized or restricted to superficial lymph nodes. Affected lymph nodes may become fluctuant and drain to surrounding tissue. They may be accompanied by fever, chills, weakness, and fatigue.
Other causes
Drugs
Phenytoin may cause generalized lymphadenopathy.
Immunizations
Typhoid vaccination may cause generalized lymphadenopathy.
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Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Edema of the arm:
Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Angioneurotic edema
Angioneurotic edema is a common reaction characterized by sudden onset of painless, nonpruritic edema affecting the hands, feet, eyelids, lips, face, neck, genitalia, or viscera. Although these swellings usually don’t itch, they may burn and tingle. If edema spreads to the larynx, signs of respiratory distress may occur.
Arm trauma
Shortly after a crush injury, severe edema may affect the entire arm. Ecchymoses or superficial bleeding, pain or numbness, and paralysis may occur. If a fracture has occurred, deformities may also be present.
Burns
Two days or less after injury, arm burns may cause mild to severe edema, pain, and tissue damage. Depending on the burn degree, the patient may also have erythema; blisters; white, brown, or leathery tissue; or charring.
Envenomation
Envenomation initially may cause edema around the bite or sting that quickly spreads to the entire arm. Pain, erythema, and pruritus at the site are common; paresthesia occurs occasionally. Later, the patient may develop generalized signs and symptoms, such as nausea, vomiting, weakness, muscle cramps, fever, chills, hypotension, headache and, in severe cases, dyspnea, seizures, and paralysis.
Superior vena cava syndrome
With superior vena cava syndrome, bilateral arm edema usually progresses slowly and is accompanied by facial and neck edema. Dilated veins mark these edematous areas. The patient also complains of headache, vertigo, and vision disturbances.
Thrombophlebitis
Thrombophlebitis may cause arm edema, pain, and warmth. Deep vein thrombophlebitis can also produce cyanosis, fever, chills, and malaise. Superficial thrombophlebitis also causes redness, tenderness, and induration along the vein.
Other causes
Treatments
Localized arm edema may result from infiltration of I.V. fluid into the interstitial tissue. A radical or modified radical mastectomy that disrupts lymphatic drainage may cause edema of the entire arm, as can axillary lymph node dissection. Also, radiation therapy for breast cancer may produce arm edema immediately after treatment or months later.
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Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Edema of the face:
Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Abscess (periodontal)
A periodontal abscess can cause edema of the side of the face, pain, warmth, erythema, and purulent discharge around the affected tooth. The gums may be bright red and inflamed.
Abscess (peritonsillar)
A peritonsillar abscess, a complication of tonsillitis, may cause unilateral facial edema. Other key signs and symptoms include severe throat pain, neck swelling, drooling, cervical adenopathy, fever, chills, and malaise.
Allergic reaction
Facial edema may characterize local allergic reactions and anaphylaxis. With life-threatening anaphylaxis, angioneurotic facial edema may occur with urticaria and flushing. (See Recognizing angioneurotic edema.) Airway edema causes hoarseness, stridor, and bronchospasm with dyspnea and tachypnea. Signs of shock, such as hypotension and cool, clammy skin, may also occur. A localized reaction produces facial edema, erythema, and urticaria.
Chalazion
A chalazion causes localized swelling and tenderness of the affected eyelid, accompanied by a small red lump on the conjunctival surface. The patient may report increased tearing and photophobia.
Conjunctivitis
Conjunctivitis causes eyelid edema, excessive tearing, and itchy, burning eyes. Inspection reveals a thick purulent discharge, crusty eyelids, and conjunctival injection. Corneal involvement causes photophobia and pain.
Corneal ulcers (fungal)
In patients with fungal corneal ulcers, red, edematous eyelids accompany conjunctival injection, intense pain, photophobia, and severely impaired visual acuity. Copious, purulent eye discharge makes eyelids sticky and crusted. The characteristic dense, central ulcer grows slowly, is whitish gray, and is surrounded by progressively clearer rings.
Dacryocystitis
With dacryocystitis, lacrimal sac inflammation causes prominent eyelid edema and constant tearing. In acute cases, pain and tenderness near the tear sac accompany purulent discharge.
CULTURAL CUE:
Dacryocystitis rarely occurs in blacks because they tend to have a larger nasolacrimal ostium and a shorter, straighter lacrimal canal than whites.
Facial burns
Burns may cause extensive edema that impairs respiration. Additional findings include singed nasal hairs and eyebrows, red mucosa, sooty sputum, and signs of respiratory distress, such as inspiratory stridor.
Facial trauma
With facial trauma, the extent of edema varies with the type of injury. For example, a contusion may cause localized edema, whereas a nasal or maxillary fracture causes more generalized edema. Associated signs and symptoms also depend on the type of injury.
Herpes zoster ophthalmicus
With herpes zoster ophthalmicus (also known as shingles), edematous and red eyelids are usually accompanied by excessive tearing and a serous discharge. Severe unilateral facial pain may occur several days before vesicles erupt. Fever and malaise may also occur.
Hordeolum
Typically, localized eyelid edema, erythema, and pain occur with a hordeolum (stye). The patient may report photophobia and a foreign body sensation.
Malnutrition
Severe malnutrition causes facial edema followed by swelling of the feet and legs. Associated signs and symptoms include muscle atrophy and weakness; anorexia; diarrhea; lethargy; dry, wrinkled skin; sparse, brittle, easily plucked hair; and slowed pulse and respiratory rates.
Myxedema
Myxedema eventually causes generalized facial edema; waxy, dry skin; hair loss or coarsening; and other signs of hypothyroidism. Upper eyelid drooping may also be apparent.
Nephrotic syndrome
Commonly the first sign of nephrotic syndrome, periorbital edema precedes dependent and abdominal edema. Associated findings include weight gain, nausea, anorexia, lethargy, fatigue, and pallor.
Orbital cellulitis
Sudden onset of periorbital edema marks orbital cellulitis, an inflammatory disorder. It may be accompanied by a unilateral purulent discharge, hyperemia, exophthalmos, conjunctival injection, impaired extraocular movements, fever, and extreme orbital pain.
Preeclampsia
Edema of the face, hands, and ankles is an early sign of preeclampsia. Other characteristics include excessive weight gain, severe headache, blurred vision, hypertension, and midepigastric pain.
Rhinitis (allergic)
With allergic rhinitis, red and edematous eyelids are accompanied by paroxysmal sneezing, itchy nose and eyes, and profuse, watery rhinorrhea. The patient may also develop nasal congestion, excessive tearing, headache, sinus pain, and sometimes malaise and fever.
Sinusitis
Frontal sinusitis causes edema of the forehead and eyelids. Maxillary sinusitis produces edema in the maxillary area as well as malaise, gingival swelling, and trismus. Both types are also accompanied by facial pain, fever, nasal congestion, purulent nasal discharge, and red, swollen nasal mucosa.
Superior vena cava syndrome
Superior vena cava syndrome gradually produces facial and neck edema accompanied by thoracic or jugular vein distention. It also causes central nervous system symptoms, such as headache, vision disturbances, and vertigo.
Other causes
Diagnostic tests
An allergic reaction to contrast media used in radiologic tests may produce facial edema.
Drugs
Long-term use of glucocorticoids may produce facial edema. Any drug that causes an allergic reaction (aspirin, antipyretics, penicillin, and sulfa preparations, for example) may have the same effect. Ingestion of the fruit pulp of ginkgo biloba can cause severe erythema and edema and the rapid formation of vesicles.
Surgery and transfusion
Cranial, nasal, or jaw surgery may cause facial edema, as may a blood transfusion that causes an allergic reaction.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Edema of the leg:
Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Burns
Two days or less after injury, leg burns may cause mild to severe edema, pain, and tissue damage. Depending on the degree of the burn, the patient may also have erythema; blisters; white, brown, or leathery tissue; or charring.
Cellulitis
With cellulitis, pitting edema and orange peel skin are caused by a streptococcal or staphylococcal infection that most commonly occurs in the lower extremities. Cellulitis is also associated with erythema, warmth, and tenderness in the infected area.
Envenomation
Mild to severe localized edema may develop suddenly at the site of a bite or sting, along with erythema, pain, urticaria, pruritus, and a burning sensation. Later signs include nausea, vomiting, weakness, muscle cramps, fever, chills, hypotension, headache, and, in severe cases, dyspnea, seizures, and paralysis.
Heart failure
Bilateral leg edema is an early sign of right-sided heart failure. Other signs and symptoms include weight gain despite anorexia, nausea, chest tightness, hypotension, pallor, tachypnea, exertional dyspnea, orthopnea, paroxysmal nocturnal dyspnea, palpitations, ventricular gallop, and inspiratory crackles. Pitting ankle edema, hepatomegaly, hemoptysis, and cyanosis signal more advanced heart failure.
Hypoproteinemia
Malnourished patients suffer bilateral leg edema secondary to decreased protein and osmotic pressures. Malnutrition also typically causes muscle weakness; lethargy; anorexia; diarrhea; apathy; dry, wrinkled skin; and signs of anemia, such as dizziness and pallor.
Leg trauma
Mild to severe localized edema may form around the site of leg trauma. Ecchymoses or bleeding, pain or numbness, and paralysis may occur. If a fracture has occurred, deformities may be present.
Nephrotic syndrome
Nephrotic syndrome is commonly seen in children and results in bilateral leg edema. It’s associated with polyuria and eyelid swelling. Generalized pitting edema may also occur as well as ascites, fatigue, malaise, depression, and pallor.
Osteomyelitis
When osteomyelitis, a bone infection, affects the lower leg, it usually produces localized, mild to moderate edema, which may spread to the adjacent joint. Edema typically follows fever, localized tenderness, and pain that increases with leg movement.
Rupture of popliteal cyst
A ruptured popliteal (Baker’s) cyst can cause sudden onset of unilateral calf pain and edema, usually after walking or exercising. This type of cyst is common in patients with arthritis. It can compress vascular structures and cause severe edema and thrombophlebitis.
Thrombophlebitis
Both deep and superficial vein thrombosis may cause unilateral mild to moderate edema. Deep vein thrombophlebitis may not produce symptoms or may cause mild to severe pain, warmth, and cyanosis in the affected leg as well as fever, chills, and malaise. Superficial thrombophlebitis typically causes pain, warmth, redness, tenderness, and induration along the affected vein.
Venous insufficiency (chronic)
Moderate to severe, unilateral or bilateral leg edema occurs in patients with chronic venous insufficiency. Initially, the edema is soft and pitting; later, it becomes hard as tissues thicken. Other signs include darkened skin and painless, easily infected stasis ulcers around the ankle. Venous insufficiency generally occurs in females.
Other causes
Coronary artery bypass surgery
Unilateral venous insufficiency may follow saphenous vein retrieval.
Medications
Estrogen, hormonal contraceptives, lithium, nonsteroidal anti-inflammatory drugs, vasodilators, and drugs that cause sodium retention can cause bilateral leg edema.
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Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Edema:
Principal Causes of Edema
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)
- Disorderswith normal serum albumin
- Increased capillary permeability
- Skin disorders
- Allergic reaction
- Vasculitis
- Septicemia
- Vitamin E deficiency
- Hereditary angioedema
- Increased hydrostatic pressure
- Increasedblood volume
- Fluidoverload
- Cardiac failure
- Renal disease
- Increased venous pressure
- Constructivepericarditis
- Portal hypertension
- Venous thrombosis
- Tumor
- Increased lymph pressure
- Lymphedema
- Disorders with decreased serum albumin(decreased oncotic pressure)
- Disorders with proteinuria
- Renaldisease
- Glomerulonephritis
- Nephrotic syndrome
- Disorders without proteinuria
- Acuteand chronic liver disease
- Hepatitis
- Cirrhosis
- Gastrointestinal disease
- Protein-losingenteropathy
- Cowmilk protein sensitivity
- Cystic fibrosis
- Celiac disease
- Inflammatory bowel disease
- Intestinal lymphangiectasia
- Protein-calorie malnutrition
- Congenital albumin deficiency
- Hydrops fetalis: immune and nonimmune
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Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006
Lymphadenopathy:
Principal Causes of Localized Lymphadenopathy
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)
- Localizedlymphadenopathy
- Cervical
- Submandibular/submental
- Preauricular
- Postauricular
- Occipital
- Supraclavicular
- Axillary
- Epitrochlear
- Inguinal
- Femoral
- Popliteal
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Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006
Edema, generalized:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Angioneurotic edema or angioedema.Recurrent attacks of acute, painless, nonpitting edema involving the skin and mucous membranes—especially those of the respiratory tract, face, neck, lips, larynx, hands, feet, genitalia, or viscera—may be the result of a food or drug allergy or emotional stress or they may be hereditary. Abdominal pain, nausea, vomiting, and diarrhea accompany visceral edema; dyspnea and stridor accompany life-threatening laryngeal edema.
Burns.Edema and associated tissue damage vary with the severity of the burn. Severe generalized edema (4+) may occur within 2 days of a major burn; localized edema may occur with a less severe burn.
Heart failure.Severe, generalized pitting edema—occasionally anasarca—may follow leg edema late in this disorder. The edema may improve with exercise or elevation of the limbs and is typically worse at the end of the day. Among other classic late findings are hemoptysis, cyanosis, marked hepatomegaly, clubbing, crackles, and a ventricular gallop. Typically, the patient has tachypnea, palpitations, hypotension, weight gain despite anorexia, nausea, a slowed mental response, diaphoresis, and pallor. Dyspnea, orthopnea, tachycardia, and fatigue typify leftsided heart failure; jugular vein distention, enlarged liver, and peripheral edema typify right-sided heart failure.
Malnutrition.Anasarca in malnutrition may mask dramatic muscle wasting. Malnutrition also typically causes muscle weakness; lethargy; anorexia; diarrhea; apathy; dry, wrinkled skin; and signs of anemia, such as dizziness and pallor.
Myxedema.With myxedema, which is a severe form of hypothyroidism, generalized nonpitting edema is accompanied by dry, flaky, inelastic, waxy, pale skin; a puffy face; and an upper eyelid droop. Observation also reveals masklike facies, hair loss or coarsening, and psychomotor slowing. Associated findings include hoarseness, weight gain, fatigue, cold intolerance, bradycardia, hypoventilation, constipation, abdominal distention, menorrhagia, impotence, and infertility.
Nephrotic syndrome.Although nephrotic syndrome is characterized by generalized pitting edema, it's initially localized around the eyes. With severe cases, anasarca develops, increasing body weight by up to 50%. Other common signs and symptoms are ascites, anorexia, fatigue, malaise, depression, and pallor.
Pericardial effusion.With pericardial effusion, generalized pitting edema may be most prominent in the arms and legs. It may be accompanied by chest pain, dyspnea, orthopnea, a nonproductive cough, a pericardial friction rub, jugular vein distention, dysphagia, and a fever.
Pericarditis (chronic constrictive).Resembling right-sided heart failure, pericarditis usually begins with pitting edema of the arms and legs that may progress to generalized edema. Other signs and symptoms include ascites, Kussmaul's sign, dyspnea, fatigue, weakness, abdominal distention, and hepatomegaly.
Renal failure.With acute renal failure, generalized pitting edema occurs as a late sign. With chronic renal failure, edema is less likely to become generalized; its severity depends on the degree of fluid overload. Both forms of renal failure cause oliguria, anorexia, nausea and vomiting, drowsiness, confusion, hypertension, dyspnea, crackles, dizziness, and pallor.
Other causes
Drugs.Any drug that causes sodium retention may aggravate or cause generalized edema. Examples include antihypertensives, corticosteroids, androgenic and anabolic steroids, estrogens, and nonsteroidal anti-inflammatory drugs, such as phenylbutazone, ibuprofen, and naproxen.
Treatments.I.V. saline solution infusions and internal feedings may cause sodium and fluid overload, resulting in generalized edema, especially in patients with cardiac or renal disease.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Lymphadenopathy:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Acquired immunodeficiency syndrome (AIDS).Besides lymphadenopathy, findings with AIDS include a history of fatigue, night sweats, afternoon fevers, diarrhea, weight loss, and a cough with several concurrent infections appearing soon afterward.
Anthrax (cutaneous).Lymphadenopathy, malaise, headache, and fever may develop with cutaneous anthrax, along with a lesion that progresses into a painless, necrotic-centered ulcer.
Brucellosis.With brucellosis, generalized lymphadenopathy usually affects cervical and axillary lymph nodes, making them tender. It usually begins insidiously with easy fatigability, malaise, a headache, backache, anorexia, weight loss, and arthralgia; it may also begin abruptly with chills, a fever that usually rises in the morning and subsides during the day, and diaphoresis.
Cytomegalovirus infection (CMV).CMV causes generalized lymphadenopathy occurs in the immunocompromised patient and is accompanied by fever, malaise, rash, and hepatosplenomegaly.
Hodgkin's disease.The extent of lymphadenopathy with Hodgkin's disease reflects the stage of malignancy—from stage I involvement of a single lymph node region to stage IV generalized lymphadenopathy. Common early signs and symptoms include pruritus and, in older patients, fatigue, weakness, night sweats, malaise, weight loss, and an unexplained fever (usually up to 101º F [38.3º C]). Also, if mediastinal lymph nodes enlarge, tracheal and esophageal pressure produces dyspnea and dysphagia.
Kawasaki syndrome.Cervical lymphadenopathy is a characteristic sign of Kawasaki syndrome, a potentially life-threatening illness. Affected individuals present with a high, spiking fever, along with other diagnostic signs including erythema, bilateral conjunctival injection, and swelling in the peripheral extremities. Kawasaki syndrome isn't contagious, however the cause remains unknown and the disease typically affects children under age 5. Prompt detection and treatment with I.V. gamma globulin is essential in preventing serious complications, such as coronary artery dilations and aneurysms.
Leptospirosis.Lymphadenopathy is uncommon in leptospirosis, a rare disease. More common findings include a sudden onset of a fever and chills, malaise, myalgia, a headache, nausea and vomiting, and abdominal pain.
Leukemia (acute lymphocytic).With acute lymphocytic leukemia, generalized lymphadenopathy is accompanied by fatigue, malaise, pallor, and a low-grade fever. The patient also experiences prolonged bleeding time, swollen gums, weight loss, bone or joint pain, and hepatosplenomegaly.
Leukemia (chronic lymphocytic).With chronic lymphocytic leukemia, generalized lymphadenopathy appears early, along with fatigue, malaise, and a fever. As the disease progresses, hepatosplenomegaly, severe fatigue, and weight loss occur. Other late findings include bone tenderness, edema, pallor, dyspnea, tachycardia, palpitations, bleeding, anemia, and macular or nodular lesions.
Lyme disease.Spread by the bite of certain ticks, Lyme disease begins with a skin lesion called erythema chronicum migrans. As the disease progresses, the patient may suffer from lymphadenopathy, constant malaise and fatigue, an intermittent headache, a fever, chills, and aches. He may go on to develop arthralgia and, eventually, neurologic and cardiac abnormalities.
Monkeypox.Lymphadenopathy is the one symptom that clearly distinguishes monkeypox from smallpox. Humans infected with monkeypox usually develop cervical or inguinal lymphadenopathy, along with other characteristic symptoms such as fever, chills, throat pain, muscle aches, and rash. This rare viral disease acquired its name after being discovered in laboratory monkeys; however, many other animals can carry this disease. Although the monkeypox virus is similar to smallpox, the smallpox vaccine is only used in limited circumstances to protect certain at-risk individuals against the disease.
Mononucleosis (infectious).With infectious mononucleosis, characteristic, painful lymphadenopathy involves cervical, axillary, and inguinal nodes. Posterior cervical adenopathy is also common. Typically, prodromal symptoms—such as a headache, malaise, and fatigue—occur 3 to 5 days before the appearance of the classic triad of lymphadenopathy, a sore throat, and temperature fluctuations with an evening peak of about 102º F (38.9º C). Hepatosplenomegaly may develop, along with findings of stomatitis, exudative tonsillitis, or pharyngitis.
Mycosis fungoides.Lymphadenopathy occurs in stage III of mycosis fungoides, a rare, chronic malignant lymphoma. It's accompanied by ulcerated brownish red tumors that are painful and itchy.
Non-Hodgkin's lymphoma.Painless enlargement of one or more peripheral lymph nodes is the most common sign of non-Hodgkin's lymphoma, with generalized lymphadenopathy characterizing stage IV. Dyspnea, a cough, and hepatosplenomegaly occur, along with systemic complaints of a fever of up to 101° F (38.3º C), night sweats, fatigue, malaise, and weight loss.
Plague (Yersinia pestis).Signs and symptoms of the bubonic form of plague, a bacterial infection, include lymphadenopathy, a fever, and chills.
Rheumatoid arthritis.Lympha-
denopathy is an early, nonspecific finding in rheumatoid arthritis and is associated with fatigue, malaise, a continuous low-grade fever, weight loss, and vague arthralgia and myalgia. Later, the patient develops joint tenderness, swelling, and warmth; joint stiffness after inactivity (especially in the morning); and subcutaneous nodules on the elbows. Eventually joint deformity, muscle weakness, and atrophy may occur.
Sarcoidosis.With sarcoidosis, generalized, bilateral hilar and right paratracheal forms of lymphadenopathy (seen on chest X-ray) with splenomegaly are common. Initial findings are arthralgia, fatigue, malaise, weight loss, and pulmonary symptoms. Other findings vary with the site and extent of fibrosis. Typical cardiopulmonary findings include breathlessness, a cough, substernal chest pain, and arrhythmias. About 90% of patients have an abnormal chest X-ray at some time during their illness. Musculoskeletal and cutaneous features may include muscle weakness and pain, phalangeal and nasal mucosal lesions, and subcutaneous skin nodules. Common ophthalmic findings include eye pain, photophobia, and nonreactive pupils. Central nervous system involvement may produce cranial or peripheral nerve palsies and seizures.
Sjögren's syndrome.Lymphadenopathy of the parotid and submaxillary nodes may occur in Sjögren's syndrome, a rare disorder. Assessment reveals cardinal signs of dry mouth, eyes, and mucous membranes, which may be accompanied by photosensitivity, poor vision, eye fatigue, nasal crusting, and epistaxis.
Syphilis (secondary).Generalized lymphadenopathy occurs in the second stage of syphilis and may be accompanied by a macular, papular, pustular, or nodular rash on the arms, trunk, palms, soles, face, and scalp. A palmar rash is a significant diagnostic sign. Headache, malaise, anorexia, weight loss, nausea, vomiting, sore throat, and low-grade fever may occur.
Systemic lupus erythematosus (SLE).With SLE, generalized lymphadenopathy typically accompanies the hallmark butterfly rash, photosensitivity, Raynaud's phenomenon, and joint pain and stiffness. Pleuritic chest pain and a cough may appear with systemic findings, such as a fever, anorexia, and weight loss.
Tuberculous lymphadenitis.Lymphadenopathy that occurs with tuberculous lymphadenitis may be generalized or restricted to superficial lymph nodes. Affected lymph nodes may become fluctuant and drain to surrounding tissue. They may be accompanied by a fever, chills, weakness, and fatigue.
Waldenström's macroglobulinemia.
Lymphadenopathy may appear along with hepatosplenomegaly in Waldenström's macroglobulinemia. Associated findings include retinal hemorrhage, pallor, and signs of heart failure, such as jugular vein distention and crackles. The patient shows a decreased level of consciousness, abnormal reflexes, and signs of peripheral neuritis. Weakness, fatigue, weight loss, epistaxis, and GI bleeding may also occur. Circulatory impairment occurs because of increased blood viscosity.
Other causes
Drugs.Phenytoin may cause generalized lymphadenopathy.
Immunizations.Typhoid vaccination may cause generalized lymphadenopathy.
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Source: Nursing: Interpreting Signs and Symptoms, 2007
Edema of the arm:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Angioneurotic edema.Angioneurotic edema is a common reaction that's characterized by the sudden onset of painless, nonpruritic edema affecting the hands, feet, eyelids, lips, face, neck, genitalia, or viscera. Although swelling usually doesn't itch, it may burn and tingle. If edema spreads to the larynx, signs of respiratory distress may occur.
Arm trauma.Shortly after a crush injury, severe edema may affect the entire arm. Ecchymoses or superficial bleeding, pain or numbness, and paralysis may occur.
Burns.Two days or less after injury, arm burns may cause mild to severe edema, pain, and tissue damage.
Envenomation.Envenomation by snakes, aquatic animals, or insects initially may cause edema around the bite or sting that quickly spreads to the entire arm. Pain, erythema, and pruritus at the site are common; paresthesia occurs occasionally. Later, the patient may develop generalized signs and symptoms, such as nausea, vomiting, weakness, muscle cramps, a fever, chills, hypotension, a headache and, in severe cases, dyspnea, seizures, and paralysis.
Superior vena cava syndrome.Bilateral arm edema usually progresses slowly and is accompanied by facial and neck edema. Dilated veins mark these edematous areas. The patient also complains of a headache, vertigo, and vision disturbances.
Thrombophlebitis.Thrombophlebitis, which can result from peripherally inserted central catheters and arm portocaths, may cause arm edema, pain, and warmth. Deep vein thrombophlebitis can also produce cyanosis, a fever, chills, and malaise; superficial thrombophlebitis also causes redness, tenderness, and induration along the vein.
Other causes
Treatments.Localized arm edema may result from infiltration of I.V. fluid into the interstitial tissue. A radical or modified radical mastectomy that disrupts lymphatic drainage may cause edema of the entire arm, as can axillary lymph node dissection. Also, radiation therapy for breast cancer may produce arm edema immediately after treatment or months later.
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Source: Nursing: Interpreting Signs and Symptoms, 2007
Edema of the face:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Allergic reaction.Facial edema may characterize local allergic reactions and anaphylaxis. With life-threatening anaphylaxis, angioneurotic facial edema may occur with urticaria and flushing. (See Recognizing angioneurotic edema.) Airway edema causes hoarseness, stridor, and bronchospasm with dyspnea and tachypnea. Signs of shock, such as hypotension and cool, clammy skin, may also occur. A localized reaction produces facial edema, erythema, and urticaria.
Chalazion.A chalazion causes localized swelling and tenderness of the affected eyelid, accompanied by a small red lump on the conjunctival surface.
Conjunctivitis.Conjunctivitis causes eyelid edema, excessive tearing, and itchy, burning eyes. Inspection reveals a thick purulent discharge, crusty eyelids, and conjunctival injection. Corneal involvement causes photophobia and pain.
Dacryoadenitis.Severe periorbital swelling characterizes dacryoadenitis, which may also cause conjunctival injection, purulent discharge, and temporal pain.
Dacryocystitis.Lacrimal sac inflammation causes prominent eyelid edema and constant tearing. With acute cases, pain and tenderness near the tear sac accompany purulent discharge.
Facial burns.Burns may cause extensive edema that impairs respiration. Additional findings include singed nasal hairs, red mucosa, sooty sputum, and signs of respiratory distress such as inspiratory stridor.
Facial trauma.The extent of edema varies with the type of injury. For example, a contusion may cause localized edema, whereas a nasal or maxillary fracture causes more generalized edema. Associated features also depend on the type of injury.
Herpes zoster ophthalmicus (shingles).With shingles, edematous and red eyelids are usually accompanied by excessive tearing and a serous discharge. Severe unilateral facial pain may occur several days before vesicles erupt.
Myxedema.Myxedema eventually causes generalized facial edema; waxy, dry skin; hair loss or coarsening; and other signs of hypothyroidism.
Nephrotic syndrome.Commonly the first sign of nephrotic syndrome, periorbital edema precedes dependent and abdominal edema. Associated findings include weight gain, nausea, anorexia, lethargy, fatigue, and pallor.
Orbital cellulitis.The sudden onset of periorbital edema marks orbital cellulitis. It may be accompanied by a unilateral purulent discharge, hyperemia, exophthalmos, conjunctival injection, impaired extraocular movements, a fever, and extreme orbital pain.
Periodontal abscess.A periodontal abscess can cause swelling or edema of the gums and can progress to cause facial edema, ear and jaw pain, as well as tooth pain.
Preeclampsia.Edema of the face, hands, and ankles is an early sign of preeclampsia. Other characteristics include excessive weight gain, a severe headache, blurred vision, hypertension, and midepigastric pain.
Rhinitis (allergic).With rhinitis, red and edematous eyelids are accompanied by paroxysmal sneezing, itchy nose and eyes, and profuse, watery rhinorrhea. The patient may also develop nasal congestion, excessive tearing, a headache, sinus pain and, sometimes, malaise and a fever.
Sinusitis.Frontal sinusitis causes edema of the forehead and eyelids. Maxillary sinusitis produces edema in the maxillary area as well as malaise, gingival swelling, and trismus. Both types are also accompanied by facial pain, a fever, nasal congestion, purulent nasal discharge, and red, swollen nasal mucosa.
Superior vena cava syndrome.Superior vena cava syndrome gradually produces facial and neck edema accompanied by thoracic or jugular vein distention. It also causes central nervous system symptoms, such as a headache, vision disturbances, and vertigo.
Trachoma.With trachoma, edema affects the eyelid and conjunctiva and is accompanied by eye pain, excessive tearing, photophobia, and eye discharge. Examination reveals an inflamed preauricular node and visible conjunctival follicles.
Trichinosis.Trichinosis is a relatively rare infectious disorder that causes the sudden onset of eyelid edema with a fever (102° to 104° F [38.9° to 40° C]), conjunctivitis, muscle pain, itching and burning skin, sweating, skin lesions, and delirium.
Other causes
Diagnostic tests.An allergic reaction to contrast media used in radiologic tests may produce facial edema.
Drugs.Long-term use of glucocorticoids may produce facial edema (described as “moon face”). Any drug that causes an allergic reaction (aspirin, antipyretics, penicillin, and sulfa preparations, for example) may also cause edema.
Surgery and transfusion.Cranial, nasal, or jaw surgery may cause facial edema, as may a blood transfusion that causes an allergic reaction.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Edema of the leg:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Burns.Two days or less after injury, leg burns may cause mild to severe edema, pain, and tissue damage.
Cellulitis.Pitting edema and orange peel skin are caused by a streptococcal or staphylococcal infection that most commonly occurs in the lower extremities. Cellulitis is also associated with erythema, warmth, and tenderness in the infected area.
Envenomation.Mild to severe localized edema may develop suddenly at the site of a bite or sting, along with erythema, pain, urticaria, pruritus, and a burning sensation.
Heart failure.Bilateral leg edema is an early sign of right-sided heart failure. Other signs and symptoms include weight gain despite anorexia, nausea, chest tightness, hypotension, pallor, tachypnea, exertional dyspnea, orthopnea, paroxysmal nocturnal dyspnea, palpitations, a ventricular gallop, and inspiratory crackles. Pitting ankle edema, hepatomegaly, hemoptysis, and cyanosis signal more advanced heart failure.
Leg trauma.Mild to severe localized edema may form around the trauma site.
Osteomyelitis.When osteomyelitis—a bone infection—affects the lower leg, it usually produces localized, mild to moderate edema, which may spread to the adjacent joint. Edema typically follows a fever, localized tenderness, and pain that increases with leg movement.
Thrombophlebitis.Deep and superficial vein thrombosis may cause unilateral mild to moderate leg edema. Deep vein thrombophlebitis may be asymptomatic or may cause mild to severe pain, warmth, and cyanosis in the affected leg as well as a fever, chills, and malaise. Superficial thrombophlebitis typically causes pain, warmth, redness, tenderness, and induration along the affected vein.
Venous insufficiency (chronic).Moderate to severe, unilateral or bilateral leg edema occurs in patients with venous insufficiency. Initially, the edema is soft and pitting; later, it becomes hard as tissues thicken. Other signs include darkened skin and painless, easily infected stasis ulcers around the ankle. Venous insufficiency generally occurs in females.
Other causes
Coronary artery bypass surgery.Unilateral venous insufficiency may follow saphenous vein retrieval.
Diagnostic tests.Venography is a rare cause of leg edema.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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