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Please enable JavaScript in your browser to experience all the custom features of our site, including the ability to make a purchase. You must have JavaScript enabled in your browser to utilize the functionality of this website. Edema is the noticeable swelling resulting from fluid accumulation in certain body tissues.
The swelling, also referred to as dependent edema, is brought about by the accumulation of excess fluid beneath the skin in the interstitial spaces or compartments within the body tissues that are outside of the blood vessels. Occasionally pitting edema and non-pitting edema can occur without an underlying disease and it is then known as idiopathic edema.
Pregnancy can cause edema in the legs as the uterus puts pressure on the vena cava, a major blood vessel that returns blood to the heart from the legs, and progesterone relaxes the walls of the blood vessels. Standing or sitting for long periods of time particularly in hot weather can cause excess fluid to accumulate in feet, ankles and lower legs.
Low protein levels in the blood caused by malnutrition, kidney and liver disease can also cause edema. Congestive heart failure is a condition in which the heart can no longer pump efficiently, and causes fluid buildup in the lungs and other parts of the body.
Severe chronic (long-term) lung diseases, including emphysema and chronic bronchitis, increase pressure in the blood vessels that lead from the heart to the lungs.
Tiny valves inside the veins of the legs can become weakened, causing a common problem called venous insufficiency. Most incidences of edema in children and infants are related to serious health conditions, so changes in your child should be monitored to avoid complications.
Children with acute or chronic upper airway obstruction are at risk for negative-pressure pulmonary edema, associated with upper airway obstruction. While quite rare, Nephrotic Syndrome (NS), a disorder of the kidneys, can cause edema in children.
Periorbital edema should be closely monitored, as it may be the result of a more serious condition, such as congestive heart failure and liver diseases. Children and infants with diabetes may also experience edema as a side effect from insulin treatment. The diagnosis of pitting and non-pitting edema are determined by the symptoms on physical examination. Edema itself is usually a symptom of an underlying condition and can be noticed as swelling or puffiness of your face, hands, feet, legs, or around your eyes. If you experience shortness of breath, chest pain, redness or heat in a swollen edematous area, or a swelling of only one limb, consult a doctor immediately.
Depending on the causes of edema and whether it is temporary or permanent, treating edema usually focuses on treating the condition that is causing it.
If a blocked or damaged blood vessel is suspected as one of the causes of edema, surgery may be needed to improve the flow of blood.
Treating edema should include protecting any swollen, edematous areas of the body from pressure, injury and extreme temperatures.
Pitting edema can be demonstrated by applying pressure to the swollen area by depressing the skin with a finger. In non-pitting edema, which usually affects the legs or arms, pressure that is applied to the skin does not result in a persistent indentation. The focus of the rest of this article is on pitting edema, as it is by far the most common form of edema. Edema is caused by either systemic diseases, that is, diseases that affect the various organ systems of the body, or by local conditions involving just the affected extremities.
The most common local conditions that cause edema are varicose veins and thrombophlebitis (inflammation of the veins) of the deep veins of the legs. In some cases, however, edema may be a sign of a more serious underlying medical condition.
This disease causes scarring of your liver, which interferes with liver function, causing changes in the hormones and chemicals that regulate fluids in your body, as well as increasing pressure within the large blood vessel (portal vein) that carries blood from your intestine, spleen and pancreas into your liver.
When you have kidney disease, your kidneys may not be able to eliminate enough fluid and sodium from your blood. Damage to the tiny blood vessels in your kidneys (glomeruli) that filter waste and excess water from your blood can result in nephrotic syndrome. Congestive heart failure (CHF) is the result of insufficient output because of cardiac failure, high resistance in the circulation or fluid overload.
Left ventricle (LV) failure is the most common and results in decreased cardiac output and increased pulmonary venous pressure.
In the lungs LV failure will lead to dilatation of pulmonary vessels, leakage of fluid into the interstitium and the pleural space and finally into the alveoli resulting in pulmonary edema. Right ventricle (RV) failure is usually the result of long standing LV failure or pulmonary disease and causes increased systemic venous pressure resulting in edema in dependent tissues and abdominal viscera. In the illustration on the left some of the features, that can be seen on a chest-film in a patient with CHF. Increased pulmonary venous pressure is related to the pulmonary capillary wedge pressure (PCWP) and can be graded into stages, each with its own radiographic features on the chest film (Table).
In daily clinical practice however some of these features are not seen in this sequence and sometimes may not be present at all.
This can be seen in patients with chronic heart failure, mitral valve disease and in chronic obstructive lung disease.
Views of the upper lobe vessels of a patient in good condition (left) and during a period of CHF (right). In a normal chest film with the patient standing erect, the pulmonary vessels supplying the upper lung fields are smaller and fewer in number than those supplying the lung bases. The pulmonary vascular bed has a significant reserve capacity and recruitment may open previously non-perfused vessels and causes distension of already perfused vessels. First there is equalisation of blood flow and subsequently redistribution of flow from the lower to the upper lobes. The term redistribution applies to chest x-rays taken in full inspiration in the erect position. In daily clinical practice many chest films are taken in a supine or semi-erect position and the gravitational difference between the apex and the lung bases will be less. In the supine position, there will be equalisation of blood flow, which may give the false impression of redistribution.
Normally the vessels in the upper lobes are smaller than the accompanying bronchus with a ratio of 0.85 (3).
At the level of the hilum they are equal and in the lower lobes the arteries are larger with a ratio of 1.35. When there is redistribution of pulmonary blood flow there will be an increased artery-to-bronchus ratio in the upper and middle lobes. Stage II of CHF is characterized by fluid leakage into the interlobular and peribronchial interstitium as a result of the increased pressure in the capillaries. When fluid leaks into the peripheral interlobular septa it is seen as Kerley B or septal lines.
Kerley-B lines are seen as peripheral short 1-2 cm horizontal lines near the costophrenic angles. When fluid leaks into the peribronchovascular interstitium it is seen as thickening of the bronchial walls (peribronchial cuffing) and as loss of definition of these vessels (perihilar haze).
There is an increase in the caliber of the pulmonary vessels and they have lost their definition because they are surrounded by edema.
The lateral view nicely demonstrates the increased diameter of the pulmonary vessels and the hazy contours. Subtle ground glass opacity in the dependent part of the lungs (HU difference of 100-150 between the dependent and non-dependent part of the lung).
In a patient with a known malignancy lymphangitic carcinomatosis would be high in the differential diagnostic list. Ground glass opacity is the first presentation of alveolar edema and a precursor of consolidation. This stage is characterized by continued fluid leakage into the interstitium, which cannot be compensated by lymphatic drainage. This eventually leads to fluid leakage in the alveoli (alveolar edema) and to leakage into the pleural space (pleural effusion). After treatment we can still see an enlarged cardiac silhouette, pleural fluid and redistribution of the pulmonary blood flow, but the edema has resolved. On the left another patient with alveolar edema at admission, which resolved after treatment.

When you scroll through the images and go back and forth, you will notice the difference in vascular pedicle width and distribution of pulmonary flow. Both on the chest x-ray and on the CT the edema is gravity dependent and differences in density can be measured. This is not seen when the consolidations are the result of exsudate due to infection, blood due to hemorrhage or when there is a capillary leak like in ARDS.
A possible explanation for this phenomenon could be, that the patient had been lying on his right side for a while before the x-ray was taken.
The cardiothoracic ratio (CTR) is the ratio of the transverse diameter of the heart to the internal diameter of the chest at its widest point just above the dome of the diaphragm as measured on a PA chest film. An increased cardiac silhouette is almost always the result of cardiomegaly, but occasionally it is due to pericardial effusion or even fat deposition. An increase in left ventricular volume of at least 66% is necessary before it is noticeable on a chest x-ray. Other signs of CHF are visible, such as redistribution of pulmonary flow, interstitial edema and some pleural fluid. On a supine film the cardiac silhouette will be larger due to magnification and high position of the hemidiafragms.
Exact measurements are not that helpful, but comparison to old supine films can be of value. Because of the recent cardiac surgery, the possibility of pericardial effusion was taken into account, which is nicely demonstrated on the CT-image. On the left another patient with a large cardiac silhouette on the chest x-ray due to pericardial effusion. There has to be at least 175 ml of pleural fluid, before it will be visible on a PA image as a meniscus in the costophrenic angle.
If pleural effusion is seen on a supine chest film, it means that there is at least 500 ml present. A subpulmonic effusion may follow the contour of the diaphragm making it tricky to discern. In these cases, the only way to detect pleural effusion, is when you notice that there is an increased distance between the stomach bubble and the lung. The stomach is normally located directly under the diaphragm, so, on an erect PA radiograph, the stomach bubble should always appear in close proximity to the diaphragm and the lung.
At first glance you might get the impression that there is a high position of the diaphragm. However when you notice the increased distance of the stomach air bubble to the lung base, you realize that there is a large amount of pleural fluid on both sides (arrow).
The vascular pedicle is bordered on the right by the superior vena cava and on the left by the left subclavian artery origin (6).
A vascular pedicle width less than 60 mm on a PA chest radiograph is seen in 90% of normal chest x-rays. An increase in width of the vascular pedicle is accompanied by an increased width of the azygos vein. The VPW is best used as a measure to compare serial chest x-rays of the same patient, as there is a wide range of values for the VPW. Dilation of the azygos vein is a sign of increased right atrial pressure and is usually seen when there is also an increase in the width of the vascular pedicle. The difference of the azygos diameter on an inspiration film compared to an expiration film is only 1mm. This means that the diameter of the azygos is a valuable tool whether or not there is good inspiration.
RV failure is most commonly caused by longstanding LV failure, which increases the pulmonary venous pressure and leads to pulmonary arterial hypertension, thus overloading the RV. The indication for ultrasound examination in many of these patients is abnormal liver function tests.
It is therefore important to consider the possibility of RV failure when a patient presents with liver enzyme abnormalities. These changes in caliber can be attributed to variations in blood flow in the IVC in accordance with the respiratory and cardiac cycles. Pulmonary artery-bronchus ratios in patients with normal lungs, pulmonary vascular plethora, and congestive heart failure. Pulmonary hypertension secondary to left-sided heart disease: a cause for ventilation-perfusion mismatch mimicking pulmonary embolism.
You stepped on the scale this morning and weighed three pounds more than you did a few days ago. These are just a few of the possible signs of edema, the abnormal accumulation of fluids within the body tissues. Based on the kind of edema you have, as well as the accompanying signs and symptoms, you and your doctor can discern its underlying cause. Edema of the lower extremities (ankles, feet, legs) is not uncommon in individuals with an underlying condition, such as congestive heart failure, and in patients without heart disease as well.
Because edema has so many potential causes, its treatment depends upon the underlying cause.
Natural diuretics: A number of herbs act as diuretics, including buchu, dandelion, juniper, parsley, and uva ursi. Women are especially susceptible to edema due to the hormonal fluctuation of their menstrual cycle. The following conditions may include edema among their symptoms, but edema by itself should not lead you to conclude that you have a more serious disorder. Excessive salt intake: accumulation of fluids in the space outside cells in response to increased sodium in the diet, usually in conjunction with an underlying condition. Gout: a condition of the joints, especially in the big toe, causing red, swollen, warm, and very painful joints. Varicose veins: bluish-purple, knotted veins, usually in the legs, that cause itchiness or discomfort and possibly swollen feet and ankles.
Lymphedema: accumulation of fluid in cancer patients related to the removal of lymph nodes. Congestive heart failure: shortness of breath, fatigue, weakness, cough, and swelling of the legs due to accumulation of fluids. Cardiomyopathy: a disease of the heart that reduces its ability to pump fluids, resulting in shortness of breath, swelling of the extremities, fatigue, chest pain, wheezing, and cough. Heart valve disease: usually does not have symptoms, but may cause fatigue, weakness, dizziness, chest pain, shortness of breath, and swelling, depending upon the valve malfunctioning. The accumulation of fluid within the air gaps of lungs and parenchyma is called Pulmonary Edema. Send Home Our method Usage examples Index Contact StatisticsWe do not evaluate or guarantee the accuracy of any content in this site. It is most commonly found in the feet, ankles and legs although it may also affect the face, hands and other parts of the body and body organs. Excess fluid accumulation in the lower regions of the body, such as the ankles, feet, and legs, is referred to as peripheral edema.
Pitting edema is the term used to describe edema when pressure applied to the skin of the swollen area is released and an indentation is left behind (e.g. This is most common in women who experience it in their legs and feet when they are pre-menstrual or pre-menopausal – it is then often known as cyclical edema. Fluid retention during pregnancy also can be caused by a more serious condition called pre-eclampsia. The proteins help to hold water inside the blood vessels so fluid does not leak out into the tissues. This pressure backs up in the heart and the higher pressure causes swelling in the legs and feet.
This makes it more difficult for the veins to pump blood back to the heart, and leads to varicose veins and a buildup of fluid. This condition may also occur after head injury, seizure, or accidental chemical ingestion or inhalation. As the main symptom of NS, edema is commonly seen around one or both of the eyes, also referred to as periorbital edema, but may be found in other parts of the body such as the legs. Other causes of periorbital edema in children and infants may include allergies or infections, such as conjunctivitis. However, children with diabetes should report this to their pediatrician, as it may be a symptom of cerebral edema (brain swelling), a rare but serious complication of diabetes.
The doctor will examine the skin over the swollen area to check whether it may be stretched or shiny.

Amongst others edema can indicate disease of the heart, liver, thyroid, lymphatic system or kidneys (causing salt retention).
A low dose of a diuretic (water pill) may be prescribed to reduce the swelling and help you expel the excess fluid, but it is important to remember this just treats the symptom and is not necessarily addressing the cause.
Edema most commonly occurs in the feet and legs, where it is referred to as peripheral edema. An accumulation of fluid in the interstitial air spaces (alveoli) in the lungs occurs in a disorder called pulmonary edema. If the pressing causes an indentation that persists for some time after the release of the pressure, the edema is referred to as pitting edema.
Non-pitting edema can occur in certain disorders of the lymphatic system such as lymphedema, which is a disturbance of the lymphatic circulation that may occur after a mastectomy, lymph node surgery, or congenitally. The most common systemic diseases associated with edema involve the heart, liver, and kidneys. These conditions can cause inadequate pumping of the blood by the veins (venous insufficiency). This swelling (edema) is the result of excessive fluid in your tissues — often caused by congestive heart failure or blockage in a leg vein. These problems can result in fluid accumulating in your legs and your abdominal cavity (ascites). One result of nephrotic syndrome is low levels of protein (albumin) in your blood, which can lead to fluid accumulation and edema. Chronic venous insufficiency (CVI) is a condition in which the veins in your legs are weakened or damaged and can't pump enough blood back to your heart.
Edema is not an illness, but rather a symptom of many medical conditions, among them congestive heart failure, pregnancy, cirrhosis, and premenstrual syndrome (PMS). Hormones regulate the amount of interstitial fluid relative to cells in the surrounding area. For temporary edema, such as that in women during the premenstrual phase, preventive measures may be all that is needed. Below are some common diuretics, a class of drugs used in the treatment of high blood pressure to help clear the body of excess fluid.
Teas made from these herbs may provide temporary relief; however, they are not a long-term solution because the body eventually compensates for their diuretic action.
Lie with your feet above the level of your heart to help fluid move from the legs back to the heart. This causes water from within the cells to travel outside the cells in order to dilute the sodium concentration there. The monthly increase in the production of estrogen causes a secondary increase in the hormone aldosterone. Fluid accumulates in the spaces between cells when the vital organs collect more fluid within the body than they are able to eliminate.
Some of these disorders have certain characteristic symptoms in addition to leg or ankle swelling, while some have no symptoms, at least in the early stages.
You should not attempt to diagnose yourself with a medical condition, even if your symptoms match those characteristic of a certain disorder.
Examples include the swelling that occurs during pregnancy as well as the premenstrual phase of a woman's monthly cycle.
Congestive heart, poor heart function, abnormal condition of the valves in heart or heart attacks lead to high accumulation of blood in the blood vessel of the lungs which in turn results to the fluid to be pushed out from the blood vessels to the alveoli. Cytotoxic brain edema (swelling due to increased intracellular fluid) is indicative of a disturbance in cell metabolism, and is commonly associated with hypoxic or ischemic injuries (see hypoxia, brain). Pregnant women and older adults are often affected with this condition, but it can happen to anyone.
If a blood protein, called albumin, gets too low, fluid leaks out the blood vessels and edema occurs, especially in the feet, ankles and lower legs. Because edema can be a symptom of a serious underlying disorder, and can cause serious consequences itself, it is always important to seek medical advice. Cuts, scrapes and burns in areas that have edema take much longer to heal and are open to infection. The swelling is the result of the accumulation of excess fluid under the skin in the spaces within the tissues. Any form of pressure, such as from the elastic in socks, can induce pitting with this type of edema. Another cause of non-pitting edema of the legs is called pretibial myxedema, which is a swelling over the shin that occurs in some patients with hyperthyroidism. In these diseases, edema occurs primarily because of the body's retention of too much salt (sodium chloride). The resulting increased back-pressure in the veins forces fluid stay in the extremities (especially the ankles and feet). Maybe you couldn't squeeze the ring off your finger, or your ankles looked puffy, or your pants were a little bit snug. Small blood vessels called capillaries supply the interstitial fluid with nutrients and oxygen. However, other underlying causes such as kidney disease, heart failure, and thyroid disorders require medical attention. If the leg muscles weaken or you don't get adequate exercise, fluid from the blood pools in your feet and ankles.
When we eat salty foods, we usually become thirsty and drink more fluids than normal, thus worsening the problem. Aldosterone causes the kidney to retain fluids, making some women temporarily gain a few pounds each month. Other causes that are responsible are lung infection, cocaine smoking, radiation and lung injury.
All tissues of the body are made up of cells and connective tissues that hold the cells together. Anasarca refers to the severe, widespread accumulation of fluid in the all of the tissues and cavities of the body at the same time. The capillaries also carry away the cells' waste products, which are floating in the interstitial fluid. It can also happen when the amount of fluid leaving the capillaries is greater than the amount re-entering them. Read the nutritional values labels of foods carefully — you might be surprised at what you find.
Walking, cycling, dancing, and other activities involving the legs keep the leg muscles in shape to move fluid upward.
And though many edema-causing conditions are age-related, it is never too late to get in shape and improve your overall health. To understand your symptoms and reach a diagnosis, your healthcare provider will consider your medical history, what symptoms you have, and the results of a physical examination and laboratory tests.
In many cases kidney failure, brain surgery or bleeding in the brain may increase the fluid level in the blood vessels. Diuretic medications are generally not effective, although elevation of the legs periodically during the day and compressive devices may reduce the swelling. Congestive heart failure and cirrhosis usually cause swelling of the ankles because fluid has a hard time traveling up the legs against the force of gravity. Treatment is aimed at reducing swelling if it causes reduced mobility, skin breakdown, infection, or discomfort. If you have edema related to kidney disease, your doctor will likely recommend a diet low in fats and proteins. If so, seek the assistance of a nutritionist, who can help you create a balanced diet within certain guidelines. In various diseases, excess fluid can accumulate in either one or both of these compartments. Use alcohol in moderation, and if your edema is related to liver disease, abstain entirely.

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