Edema is a common clinical sign that may indicate numerous pathologies. As a sequela of imbalanced capillary hemodynamics,
edema is an accumulation of fluid in the interstitial compartment. The chronicity and laterality of the
edema guide evaluation. Medications (e.g.,
antihypertensives, anti-inflammatory drugs,
hormones) can contribute to
edema. Evaluation should begin with obtaining a basic metabolic panel, liver function tests, thyroid function testing,
brain natriuretic peptide levels, and a urine
protein/
creatinine ratio. Validated decision rules, such as the Wells and STOP-Bang (
snoring, tired, observed, pressure, body mass index, age, neck size, gender) criteria, can guide decision-making regarding the possibility of venous thromboembolic disease and
obstructive sleep apnea, respectively. Acute unilateral lower-extremity
edema warrants immediate evaluation for
deep venous thrombosis with a
d-dimer test or compression ultrasonography. For patients with chronic bilateral lower-extremity
edema, duplex ultrasonography with reflux can help diagnose chronic
venous insufficiency. Patients with
pulmonary edema or elevated
brain natriuretic peptide levels should undergo echocardiography to assess for
heart failure.
Lymphedema is often a clinical diagnosis; lymphoscintigraphy can be performed if the diagnosis is unclear. Treatment of
edema is specific to the etiology.
Diuretics are effective but should be used only for systemic causes of
edema. Ruscus extract and
horse chestnut seed demonstrate moderate-quality evidence to improve
edema from chronic
venous insufficiency. Compression
therapy is effective for most causes of
edema.