EdemaR60.9

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 (advanced liver disease usually results in insufficient protein and renal disease results in protein loss in the urine).
• Edema in glomerulonephritis
• Edema in endocrinologic disorders (myxedema is particularly important, occurring pretibially).
• Edema in electrolyte disorders (hypokalemic edema occurs mainly in chronic laxative abuse).
• edema in systemic scleroderma
• Edema due to diabetes mellitus
• Edema due to drug action (including adrenocortical hormones, individual antihypertensives such as alpha-methydopa, minxodil, hydralazine and phenylbutazone).
• Oediopathic oedema (syndrome in which there is actual or perceived weight gain due to pathological fluid retention. This syndrome of generalized edema occurs almost exclusively in women. The diagnosis of IE is one of exclusion).

Localized edema

• Phlebedema (acute phlebedema due to phlebitis or deep vein thrombosis/ chronic venous edema due to chronic venous insufficiency = venous stasis edema)
• Lymphedema (genetic lymphedema/unclassifiable lymphedema)
• Inflammatory edema (e.g. erysipelas, abscesses, tropical parasitosis)
• Vascular malformations (congenital angiodysplasias)
• Allergic edema(angioedema histamine-mediated)
• Hereditary edema(hereditary angioedema)
• Paroxysmal non-hereditary edema(capillary leak syndrome)
• Ischemic and postischemic edema (due to ischemic capillary wall damage)
• Edema associated with Sudeck's dystrophy (see Complex regional pain syndrome type I below)
• Local edema due to altitude (acute mountain climber's disease when staying at altitudes >2,500m)
• Edema due to artifacts(back of the hand edema, chronic traumatic)
• Post-traumatic edema (temporary swelling after fractures, surgery, contusions, sprains, dislocations, and burns that resolve spontaneously 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.