TOC  | D-Dx    

Diffenrential Diagnosis      Outlines in Clinical Medicine on Physicians' Online 2001

Differential Diagnosis of Edema - Leg Swelling

Bilateral lower limb edema is a very concerning finding

1. Serious disease must be ruled out
2. Cardiac Insufficiency is usually bilateral [1]
   • a.Left ventricular systolic dysfunction is most common cardiac cause
   • b.Diastolic Dysfunction is not uncommon
   • c.Atrial fibrillation is third most common
3. Pulmonary dysfunction including pulmonary hypertension is often bilateral
4. Portal Hypertension may show Right > Left lower extremity edema
5. Dihydropyridine calcium channel blockers often cause bilateral ankle edema
6. Hypoalbuminemia from Nephrotic Syndrome, Hepatic Failure, Malnutrition, Protein Malabsorption
   • 1.Hypoalbuminemia
   • 2.Albuminuria
   • 3.Frequently present with true anasarca
7. Soft Tissue Swelling , Cellulitis, Fasciitis - infectious, eosinophilic
8. Lymphatic Insufficiency
   • a.Lymphedema
   • b.Described as woody or brawny
9. Scleroderma
   • a.Mainly begins on hands, feet
   • b.Spreads proximally
10. Myxedema (hypothyroidism)

Unilateral is usually due to obstruction of venous or lymphatic return

1. Venous Obstruction
2. Lymphatic Obstruction
3. Venous Insuffiency - usually deep vein thrombosis or after harvest of vein graft

03162001