Edema

Edema is an abnormal accumulation of interstitial fluid caused by a variety of conditions, including, for instance, generalized fluid retention and localized reactions to trauma and allergies. Edema may manifest with swelling of the extremities (peripheral edema) or with internal fluid accumulation in organs and body cavities (e.g., pulmonary edema, pleural effusion). Patients with peripheral edema usually present with painless swelling of the lower legs. A residual indentation left by pressure on the site of the swelling indicates pitting edema. Bilateral lower limb pitting edema is often a sign of cardiac failure, while generalized peripheral pitting edema with swelling of the eyelids indicates hypoalbuminemia (e.g., in nephrotic syndrome). Nonpitting edema is seen especially in patients with lymphatic disorders and thyroid conditions.

• Definition: abnormal fluid accumulation in the interstitium due to an imbalance in fluid homeostasis
• Types
  • Peripheral edema
    • Mostly swelling of lower legs, feet, and ankles, sparing the toes
    • Usually painless; possibly discomfort and difficulty walking
    • Stasis dermatitis and peripheral polyneuropathy may occur in chronic edema.
    • Either pitting; or nonpitting edema (see “Causes” below)
    • Anasarca: extreme generalized peripheral edema
    • Periorbital edema (e.g., nephrotic syndrome)
  • Internal edema
    • Interstitial pulmonary edema
    • Cerebral edema
    • Ascites
    • Pleural effusion

References:^[1]

Pitting vs. nonpitting edema

Generalized vs. localized edema

References:^[2]

• Definition: edema associated with lymphatic obstruction and reduced fluid clearance due to compromised lymphatic vessels or lymph nodes
  • Lipid-rich, protein-rich fluid in the interstitial space that has high viscosity
• Etiology
  • Primary lymphedema (rare)
    • Congenital anomaly with poorly developed lymphatic vessels
    • Characteristic finding in Turner syndrome
  • Secondary lymphedema
    • Tumors, operations , inflammation, trauma, radiation therapy
    • Infections
      • Recurrent erysipelas, leprosy, syphilis, granuloma inguinale
      • Lymphatic filariasis (elephantiasis)
• Clinical findings
  • Swelling of limbs; characteristically nonpitting edema
  • Swelling of toes and feet with deep flexion creases
  • Stemmer's sign: inability to lift a skin fold on the base of the second toe
• Stages
  • Latent stage
  • Reversible swelling
  • Gradual fibrosis
  • Irreversible elephantiasis
• Treatment
  • Conservative
    • Manual lymphatic drainage (a form of massage that is applied in direction of the heart to increase the natural drainage of lymphatic fluid) and compression garments
    • Elevation of the involved limb
    • Exercise
    • Management of underlying disease
  • Surgical
    • Resection of lymphatic vessels
    • Lymphaticovenous anastomosis and lymphatic vessel grafting
    • Vascularized lymph node transfer

In lymphedema toes are affected, in contrast to venous edema.

References:^{[3][3][4][5][6]}