Usually due to fluid leak from veins or lymphatics. Most are ‘pitting’ (remains indented after pressing), but hypothyroidism and lymphoedema are ‘non-pitting’.
Bilateral
- Venous insufficiency, usually due to age-related venous valvular incompetence
- Right heart, liver, or renal failure
- Dependent edema: effect of gravity when sitting for a prolonged period
- Pregnancy
- Calcium channel blockers
- Hypothyroidism
Unilateral
- Venous insufficiency: can be uni- or bilateral
- DVT
- Cellulitis
- Lymphoedema e.g. from the pelvic mass
Lymphoedema
Tissue swelling due to fluid leakage from lymphatic vessels.
Primary lymphoedema
Congenital lymphoedema (aka Milroy disease):
- Autosomal dominant disease
- Usually bilateral
Lymphoedema praecox (aka Meige disease):
- Onset between birth and 35 years old, usually in puberty. 4 times commoner in women
- Commonest cause of primary lymphoedema
Usually unilateral
Lymphoedema tarda:
- Onset >35 years old
- Uncommon
Secondary lymphoedema
Causes:
- Cancer
- Surgery
- Radiotherapy
Management
- Compression stockings
- Limbs elevation
- Suction assisted lipectomy
- Low-level laser therapy
- Intermittent pneumatic compression therapy