Summary
Peripheral oedema is the presence of palpable swelling resulting from increased interstitial fluid in the tissue of the extremities.[1] The most severe, generalised form of oedema is called anasarca. Oedema is caused by imbalance of the equilibrium between the hydrostatic forces that push fluid into the interstitial tissue spaces and the oncotic gradient that draws fluid into the intravascular space.[2] Normally, the small amount of net movement of fluid into the interstitial space is removed by lymphatic drainage. If this drainage is obstructed, oedema gradually develops.[3]
[Figure caption and citation for the preceding image starts]: Development of oedema: an imbalance between the filtration of fluid from the bloodstream and drainage via the lymph systemCreated by BMJ Knowledge Centre [Citation ends].
The body has a number of homeostatic mechanisms that serve to maintain this balance, and these must be overwhelmed before fluid build-up becomes evident as peripheral oedema. Clues generated by the history, physical examination, and targeted evaluation help to identify the underlying aetiology of peripheral oedema.
Differentials
Common
- Heart failure with reduced ejection fraction (HFrEF)
- Heart failure with preserved ejection fraction (HFpEF)
- Cor pulmonale
- Deep vein thrombosis
- Chronic venous insufficiency
- Nephrotic syndrome
- Cirrhosis
- Pregnancy
- Premenstrual oedema
Uncommon
- Pericardial effusion
- Constrictive pericarditis
- Restrictive cardiomyopathy
- Tricuspid regurgitation
- Sleep apnoea
- Non-thrombotic venous outflow obstruction/May-Thurner syndrome
- Hepatic venous outflow obstruction (includes Budd-Chiari syndrome, portal vein thrombosis, and hepatic veno-occlusive disease)
- Renal failure
- Protein-losing enteropathy
- Angio-oedema
- Sepsis
- Compartment syndrome
- Primary lymphoedema
- Secondary lymphoedema
- Idiopathic
- Severe malnutrition
- Hypothyroidism/myxoedema
- Medicine-induced oedema
- Ruptured Baker's cyst
- Pelvic tumour causing external pressure on pelvic veins
Contributors
Authors
Associate Professor, College of Nursing
University of Colorado Anschutz Medical Campus
Denver
CO
Disclosures
LDR declares that she has no competing interests.
Professor of Medicine
Division of Hospital Medicine
Department of Internal Medicine
University of Colorado
Denver
CO
Disclosures
EC declares that he has no competing interests.
Peer reviewers
Associate Professor
Department of Cardiology
University of Texas MD Anderson Cancer Center
Houston
TX
Disclosures
SWY declares that he has no competing interests.
Basic Physician Trainee RACP
Logan Hospital
Meadowbrook
Queensland
Australia
Disclosures
PR declares that he has no competing interests.
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