Symptoms
 

Peripheral Oedema

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Overview

  • Swelling of one or multiple limbs - usually the legs - is a common presentation that may be due to cardiac, venous, lymphatic, musculoskeletal or metabolic pathology.

Aetiology

    • Pathophysiology

    • Peripheral oedema occurs when the capillary filtration rate exceeds the lymphatic drainage rate.
    • Capillary filtration is influenced by capillary hydrostatic pressure, plasma oncotic pressure and capillary permeability.
    • Lymphatic drainage can be limited by obstruction.
    • Causes of Peripheral Oedema

    • Unilateral

    • Impaired venous drainage - DVT, venous insufficiency, pelvic tumour
    • Impaired lymphatic drainage - lymphoedema
    • Cellulitis
    • Musculoskeletal - soft tissue injury, fracture, compartment syndrome
    • Bilateral

    • Volume overload - heart failure, liver failure, renal failure, pregnancy
    • Right ventricular failure / pulmonary hypertension
    • Impaired lymphatic drainage - lymphoedema
    • Hypoalbuminaemia - malnutrition, malabsorption, nephrotic syndrome, liver (synthetic) failure
    • Endocrine - pretibial myxoedema (profound hypothyroidism)
    • Medications - NSAIDs, calcium channel blockers, aciclovir, cyclophosphamide, cyclosporine, corticosteroids, oestrogen, progesterone

History of Presenting Complaint

    • Distribution

      Whether the swelling is unilateral or bilateral.
    • Unilateral swellingSuggestive of localised cause e.g. venous or lymphatic obstruction
    • Bilateral swellingSuggestive of systemic cause
    • Timing

      When the swelling started, whether it came on suddenly or gradually, and whether it comes and goes.
    • Sudden onset oedemaMore likely to represent a severe cause such as DVT
    • Onset post traumaSuggestive of musculoskeletal cause
    • Onset post surgeryRisk factor for DVT or iatrogenic lymphoedema
    • Onset post commencement of new medicationSuggestive of drug-induced oedema
    • Cyclical with menstrual cycleSuggestive of premenstrual oedema
    • Associated Symptoms

      Whether the oedema is associated with any other symptoms.
    • Redness, warmth and tendernessSuggestive of cellulitis or DVT
    • Chest painMay suggest heart failure with cardiac pain, or DVT with PE
    • DyspnoeaSuggestive of heart failure or DVT with PE
    • Significant weight lossRed flag for ?pelvic tumour causing venous obstruction
    • Severity

      Ask about how the swelling is affecting the patient's day to day life. Some clues about severity can be:
    • Visible enlargement of the limb
    • Difficulty in moving the affected limb(s)
    • Clothes and jewelery no longer fit
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