Approach to leg edema of unclear etiology

John W. Ely, Jerome A. Osheroff, M. Lee Chambliss, Mark H. Ebell

Research output: Contribution to journalArticle

99 Citations (Scopus)

Abstract

A common challenge for primary care physicians is to determine the cause and find an effective treatment for leg edema of unclear etiology. We were unable to find existing practice guidelines that address this problem in a comprehensive manner. This article provides clinically oriented recommendations for the management of leg edema in adults. We searched on-line resources, textbooks, and MEDLINE (using the MeSH term, "edema") to find clinically relevant articles on leg edema. We then expanded the search by reviewing articles cited in the initial sources. Our goal was to write a brief, focused review that would answer questions about the management of leg edema. We organized the information to make it rapidly accessible to busy clinicians. The most common cause of leg edema in older adults is venous insufficiency. The most common cause in women between menarche and menopause is idiopathic edema, formerly known as "cyclic" edema. A common but under-recognized cause of edema is pulmonary hypertension, which is often associated with sleep apnea. Venous insufficiency is treated with leg elevation, compressive stockings, and sometimes diuretics. The initial treatment of idiopathic edema is spironolactone. Patients who have findings consistent with sleep apnea, such as daytime somnolence, load snoring, or neck circumference >17 inches, should be evaluated for pulmonary hypertension with an echocardiogram. If time is limited, the physician must decide whether the evaluation can be delayed until a later appointment (eg, an asymptomatic patient with chronic bilateral edema) or must be completed at the current visit (eg, a patient with dyspnea or a patient with acute edema [<72 hours]). If the evaluation should be conducted at the current visit, the algorithm shown in Figure 1 could be used as a guide. If the full evaluation could wait for a subsequent visit, the patient should be examined briefly to rule out an obvious systemic cause and basic laboratory tests should be ordered for later review (complete blood count, urinalysis, electrolytes, creatinine, blood sugar, thyroid stimulating hormone, and albumin).

Original languageEnglish (US)
Pages (from-to)148-160
Number of pages13
JournalJournal of the American Board of Family Medicine
Volume19
Issue number2
DOIs
StatePublished - Jul 19 2006

Fingerprint

Edema
Leg
Venous Insufficiency
Sleep Apnea Syndromes
Pulmonary Hypertension
Snoring
Spironolactone
Menarche
Urinalysis
Blood Cell Count
Textbooks
Primary Care Physicians
Thyrotropin
Menopause
Practice Guidelines
Diuretics
MEDLINE
Dyspnea
Electrolytes
Blood Glucose

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Family Practice

Cite this

Ely, J. W., Osheroff, J. A., Chambliss, M. L., & Ebell, M. H. (2006). Approach to leg edema of unclear etiology. Journal of the American Board of Family Medicine, 19(2), 148-160. https://doi.org/10.3122/jabfm.19.2.148

Approach to leg edema of unclear etiology. / Ely, John W.; Osheroff, Jerome A.; Chambliss, M. Lee; Ebell, Mark H.

In: Journal of the American Board of Family Medicine, Vol. 19, No. 2, 19.07.2006, p. 148-160.

Research output: Contribution to journalArticle

Ely, JW, Osheroff, JA, Chambliss, ML & Ebell, MH 2006, 'Approach to leg edema of unclear etiology', Journal of the American Board of Family Medicine, vol. 19, no. 2, pp. 148-160. https://doi.org/10.3122/jabfm.19.2.148
Ely, John W. ; Osheroff, Jerome A. ; Chambliss, M. Lee ; Ebell, Mark H. / Approach to leg edema of unclear etiology. In: Journal of the American Board of Family Medicine. 2006 ; Vol. 19, No. 2. pp. 148-160.
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