II. Exam: Pitting Edema

  1. Technique
    1. Examiner impresses thumb into skin over bony surface
      1. Tibia
      2. Fibula
      3. Sacrum
    2. Withdraw thumb
    3. Measure depth of pit and record in millimeters (1-4 plus Pitting Edema)
  2. Interpretation
    1. Pitting Edema
    2. Non-Pitting Edema (Brawny Edema)
      1. Myxedema
      2. Chronic inflammation
      3. Chronic Venous Stasis

III. Exam: Edema Distribution and Characteristics

  1. Dependent Edema (fluid shift in response to gravity)
    1. Standing patient accumulates fluid in feet and ankles
    2. Bed-bound patient collects fluid posteriorly (Sacrum)
  2. Chronic Leg Edema (Brawny Edema)
    1. Tissue becomes fibrotic and fails to pit
  3. Stemmer's Sign
    1. Attempt to pinch and lift skinfold at the base of the second toe (or middle finger)
    2. Negative (able to pinch skin)
      1. Does not completely exclude Lymphedema (especially if recent onset), but is more suggestive of other edema cause
      2. No swelling at base of digit is more consistent with Chronic Venous Insufficiency
      3. Pitting swelling of the base of digit is more suggestive of CHF, Nephrotic Syndrome, Cirrhosis or other similar edema
    3. Positive (unable to pinch skin)
      1. Pathognomonic for Lymphedema

Images: Related links to external sites (from Bing)

Related Studies

Ontology: Peripheral edema (C0085649)

Definition (NCI) Swelling due to an excessive accumulation of fluid in the upper or lower extremities.
Definition (NCI_CTCAE) A disorder characterized by swelling due to excessive fluid accumulation in the upper or lower extremities.
Concepts Finding (T033)
SnomedCT 206893004, 158246003, 271809000, 82014009
English EDEMA OF EXTREMITIES, EDEMA PERIPHERAL, OEDEMA OF EXTREMITIES, OEDEMA PERIPHERAL, [D]Peripheral edema, [D]Peripheral oedema, Peripheral edema, [D]Peripheral edema (context-dependent category), Edema, peripheral, Edema extremities, Edema of extremities, Edema peripheral, Oedema of extremities, Oedema peripheral, Edema Limbs, Peripheral Oedema, Limbs Edema, edema extremities, edema limbs, edema peripheral, limb edema, extremity edema, peripheral edema, Peripheral Edema, Edema limbs, Oedema extremities, [D]Peripheral oedema (situation), [D]Peripheral edema (situation), Oedema limbs, Peripheral oedema, Peripheral edema (disorder), Peripheral edema (morphologic abnormality), Edema;peripheral, Oedema;peripheral, peripheral oedema
Italian Edema periferico, Edema degli arti
Dutch perifeer oedeem, oedeem ledematen, oedeem aan extremiteiten, oedeem extremiteiten, oedeem perifeer
French Oedème des extrémités, Oedème des membres, Oedème périphérique, Oedème, extrémités, OEDEME DES EXTREMITES, OEDEME PERIPHERIQUE, Oedèmes périphériques
German Oedem der Extremitaeten, peripheres Oedem, Oedem der Gliedmassen, OEDEM EXTREMITAETEN, OEDEM PERIPHER, Oedem peripher
Portuguese Edema dos membros, Edema das extremidades, EDEMA DAS EXTREMIDADES, EDEMA PERIFERICO, Edema periférico
Spanish Edema de miembros, Edema de extremidades, Edema de las extremidades, [D]edema periférico (categoría dependiente del contexto), EDEMA DE EXTREMIDADES, EDEMA PERIFERICO, [D]edema periférico (situación), [D]edema periférico, edema periférico (anomalía morfológica), edema periférico (trastorno), edema periférico, Edema periférico
Japanese 末梢性浮腫, 四肢浮腫, マッショウセイフシュ, シシフシュ
Czech Edém končetin, Otok končetin, Periferní edém, Periferní otok
Hungarian Perifériás ödéma, Végtagok oedemája, Végtagi ödéma, Oedema a végtagokon, Ödéma a végtagokban, Peripheriás vizenyő, Végtagok ödémája, Peripheriás oedema, Végtagi oedema

Ontology: Dependent edema (C0235437)

Concepts Finding (T033)
SnomedCT 206894005, 248499004, 58692005
English EDEMA DEPENDENT, OEDEMA DEPENDENT, [D]Dependent edema, [D]Dependent oedema, Edema dependant, Oedema dependant, Edema dependent, Oedema dependent, Gravitational edema, Orthostatic edema, Postural edema, Gravitational oedema, Orthostatic oedema, Postural oedema, orthostatic edema, Oedema;dependent, dependant edema, dependent edema, gravitational edema, postural edema, Dependent edema, Dependent oedema, Dependent edema (finding), Dependent edema (morphologic abnormality), Edema;dependent, dependent oedema
Italian Edema gravitazionale, Edema declive, Edema ortostatico, Edema posturale
Dutch oedeem secundair, orthostatisch oedeem, neerhangend oedeem, zwaartekrachtsoedeem, secundair oedeem, houdingsafhankelijk oedeem, gravitatie-oedeem
French Oedème gravitationnel, Oedème dépendant, Oedème postural, Oedème orthostatique, Oedème déclive, OEDEME IDIOPATHIQUE, Oedème de gravitation
German Oedem der Gravitation folgend, orthostatisches Oedem, posturales Oedem, OEDEM ABHAENGIGE KOERPERPARTIEEN, Gravitationsoedem
Portuguese Edema de estase, Edema ortostático, Edema de posição, EDEMA IDIOPATICO, Edema gravitacional
Spanish Edema por declive, Edema postural, Edema ortostático, Edema dependiente, EDEMA GRAVITACIONAL, edema por declive, edema dependiente (hallazgo), edema postural (hallazgo), edema dependiente, edema postural (anomalía morfológica), edema postural, Edema gravitacional
Japanese 重力性浮腫, 起立性浮腫, 動性浮腫, 体位性浮腫, ドウセイフシュ, タイイセイフシュ, ジュウリョクセイフシュ, キリツセイフシュ
Czech Edém závislý na poloze těla, Ortostatický edém, Edém závislý na gravitaci, Posturální edém
Hungarian Orthostaticus oedema, Orthostatikus ödéma, Posturalis ödéma, Gravitációs ödéma, Orthostatikus oedema, Posturalis oedema, Oedema orthostatica, Gravitációs oedema, Dependens oedema, Orthostatikus vizenyő

Ontology: Pitting edema (C0333243)

Definition (NCI) Swelling due to excessive accumulation of fluid under the skin defined by a persistent indentation when pressure is applied to the swollen area. Causes include systemic conditions (e.g., heart failure, liver failure, or kidney failure) and local conditions affecting the extremities.
Concepts Sign or Symptom (T184)
SnomedCT 139248000, 161986005, 284521000, 5008001
English pitting edema, pitting edema (physical finding), Pitting Edema, oedema pitting, edema pitted, edema pitting, edema pits, pit edema, pitting oedema, Pitting oedema (finding), Pitting edema, Pitting oedema, Pitting edema (finding), Pitting edema (morphologic abnormality), edema; pitting, pitting; edema
Spanish Edema depresible, edema con fóvea (anomalía morfológica), edema con fóvea (hallazgo), edema con fóvea
Portuguese Edema com godet, Edema depressível
French Oedème prenant le godet, Oedème qui prend le godet
Italian Edema plastico
German eindrueckbares Oedem, Eindrueckbares Oedem
Dutch putjesoedeem, oedeem; putjes, putjes; oedeem
Czech Hydrostatický intersticiální edém
Japanese 圧痕浮腫, アッコンフシュ
Hungarian Ujjbenyomatot tartó ödéma, Ujjbenyomatot tartó oedema

Ontology: Brown edema (C0333248)

Concepts Sign or Symptom (T184)
SnomedCT 248500008, 18174004
English edema brown, brawny edema, browning edema, edema brawny, Brawny edema, Brawny oedema, Brown edema, Brown oedema, Brawny edema (finding), Brown edema (morphologic abnormality)
Spanish edema indurado con coloración parda (hallazgo), edema indurado con coloración parda, edema pardo (anomalía morfológica), edema pardo