Edema R60.9

Edema is a pathological accumulation of fluid in the interstitial space.

With regard to the differential diagnosis of edema, the localization provides the first clues. Generalized edema indicates a disorder affecting the entire organism. Classic examples are cardiac insufficiency and hypoproteinemia. If the edema is localized, the first line of investigation is a regional disorder. Examples include lymphedema, phlebedema, and traumatic edema. When evaluating lower extremity edema, it should be noted that swelling of a lesser degree may be physiologic in nature. Prolonged sitting while driving a car or in an airplane may be the cause. Premenstrual edema is also well known.

Generalized edema

• Edema in heart failure
• Edema in hypoproteinemia (in advanced liver disease, too little protein is usually produced and in kidney disease, protein is lost in the urine).
• Edema in glomerulonephritis
• Edema in endocrinological disorders (myxedema is particularly important here, as it occurs preferentially pretibially)
• Edema in electrolyte disorders (hypokalemic edema occurs mainly in chronic laxative abuse)
• Edema in systemic scleroderma
• Edema in diabetes mellitus
• Edema due to the effects of medication (these include: adrenocortical hormones, individual antihypertensives e.g. alpha-methydopa, Minxodil, Hydralazine and Phenylbutazone).
• Oediopathic oedema (syndrome in which there is actual or perceived weight gain as a result of pathological fluid retention. This syndrome of generalized oedema occurs almost exclusively in women. The diagnosis of IE is a diagnosis of exclusion).

Localized oedema

• Phleboedema (acute phleboedema in phlebitis or deep vein thrombosis/chronic venous oedema in chronic venous insufficiency = venous stasis oedema)
• Lymphoedema (genetic lymphoedema/unclassifiable lymphoedema)
• Inflammatory oedema (e.g. erysipelas, abscesses, tropical parasitosis)
• Vascular malformations (congenital angiodysplasia)
• Allergic oedema(histamine-mediated angioedema)
• Hereditary edema(hereditary angioedema)
• Paroxysmal non-hereditary edema(capillary leak syndrome)
• Ischemic and post-ischemic edema (due to ischemic capillary wall damage)
• Edema in Sudeck's dystrophy (see complex regional pain syndrome type I below)
• Altitude-related local edema (acute mountain sickness when staying at altitudes >2,500m)
• Edema due to artifacts(edema on the back of the hand, chronic traumatic edema)
• Post-traumatic oedema (temporary swelling after bone fractures, operations, bruises, sprains, dislocations and burns, which spontaneously disappear after days to weeks).

With regard to the differential diagnosis of edema, the localization provides the first clues. Generalized edema indicates a disorder affecting the entire organism. Classic examples are cardiac insufficiency and hypoproteinemia. If the edema is localized, the first line of investigation is a regional disorder. Examples include lymphedema, phlebedema, and traumatic edema. When evaluating lower extremity edema, it should be noted that swelling of a lesser degree may be physiologic in nature. Prolonged sitting while driving a car or in an airplane may be the cause. Premenstrual edema is also well known.