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A. Bilateral versus Unilateral Edema navigator

  1. Cardiac Insufficiency is usually bilateral [1]
    1. Left ventricular systolic dysfunction is most common cardiac cause
    2. Diastolic Dysfunction is not uncommon
    3. Atrial fibrillation is third most common
  2. Pulmonary dysfunction including pulmonary hypertension is often bilateral
  3. Portal Hypertension may show Right > Left lower extremity edema
  4. Unilateral is usually due to obstruction of venous or lymphatic return
    1. Venous Obstruction
    2. Lymphatic Obstruction
    3. Venous Insuffiency - usually after harvest of vein graft or deep vein thrombosis
  5. Drugs (usually bilateral ankle edema)
    1. Calcium channel blockers: Dihydropyridine more than others
    2. Direct vasodilators
    3. Antihypertensive agents
    4. Direct vasodilators: minoxidil, diazoxide, hydralazine
    5. Estrogen/progesterone
    6. Testosterone
    7. Glucocorticoids
    8. NSAIDs (nonspecific and COX2 selective)
    9. Glitazones
    10. Phenylbutazone
    11. Monoamine oxidase inhibitors (MAO-I)
    12. Antidepressants

B. Nephrotic Syndrome navigator

  1. Hypoalbuminemia
  2. Albuminuria
  3. Frequently present with true anasarca

C. Failure of Albumin Synthesis navigator

  1. Hepatic Failure
  2. Protein Malabsorption 3 Malnutrition with hypoproteinemia

D. Soft Tissue Swellingnavigator

  1. Myxedema (hypothyroidism)
  2. Lymphatic Insufficiency
    1. Lymphedema
    2. Described as woody or brawny
  3. Scleroderma
    1. Mainly begins on hands, feet
    2. Spreads proximally
  4. Scleredema - on back and shoulders
  5. Fasciitis - infectious, eosinophilic

References navigator

  1. Blankfield RP, Finkelhor RS, Alexander JJ, et al. 1998. Am J Med. 105(3):192 abstract
  2. Cho S and Atwood E. 2002. Am J Med. 113(7):580 abstract