EDEMA, LOCALIZED

Ask the following questions:

1. Is the edema acute or chronic? Acute edema, if it is localized, should always bring to mind a deep vein thrombophlebitis. It also should bring to mind acute lymphangitis, particularly if there is erythema in the area. Finally, it should also make one think of trauma or a focal infection such as cellulitis. Chronic localized edema, on the other hand, is more likely related to varicose veins or lymphedema.
2. Is the edema pitting or nonpitting? If the edema pits, it is more likely related to inflammation or venous incompetence. If it is nonpitting, it is more likely due to obstruction of the lymphatics, i.e., lymphedema.
3. Is there erythema, a rash, or focal tenderness, or all three? Erythema and focal tenderness would suggest cellulitis, lymphangitis, thrombophlebitis, angioneurotic edema, insect bite, or snake bite. It also would suggest a sprain or contusion. Focal tenderness alone with pitting edema and no significant erythema or rash would suggest a deep vein thrombophlebitis. When there is no erythema or tenderness in a case of pitting edema of a localized nature, one should consider varicose veins or, in the lower extremities, a popliteal cyst that might be obstructing the veins on a chronic basis.
4. If the edema is of the lower extremities, is there a positive Homans' sign? A positive Homans' sign should always be looked for because this would suggest a deep vein thrombophlebitis. Action must be taken immediately in such cases.

DIAGNOSTIC WORKUP

A venous ultrasound study, impedance plethysmography, and contrast venography are very useful in the diagnosis of deep vein thrombophlebitis. d -dimer testing is also a sensitive indicator of active deep vein thrombophlebitis and the need for anticoagulants. Patients with suspected cellulitis or osteomyelitis should have a CBC, sedimentation rate, and cultures of the blood or any fluid that is available from the site of the lesion, either direct or by aspiration. X-rays and CT scans of the involved area are useful as well. Bone scans are often of value in diagnosing osteomyelitis and fractures. Lymphangiography will be helpful in the diagnosis of carcinomatosis or lymphedema from other causes. A CT scan of the abdomen or pelvis may also demonstrate the malignant lymph nodes. A thyroid profile will diagnose cases of pretibial myxedema due to thyrotoxicosis. Patients with upper extremity edema should have a chest x-ray and CT scan of the mediastinum to determine the causes of superior vena cava syndrome.

Book Source Details

• Book Title: Algorithmic Diagnosis of Symptoms and Signs
• Author(s): R. Douglas Collins
• Year of Publication: 2003
• Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.

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Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2008 Williams & Wilkins.

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More About This Book: Title: Algorithmic Diagnosis of Symptoms and Signs Authors: R. Douglas Collins Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 0-7817-3805-9

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