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What Can One Do When The Cause Of Peripheral Pitting Edema Cannot Be Found Medically?

Posted on Thu, 21 Mar 2024

Question: Yes thanks. My sister has peripheral pitting edema for 2 months now and all of the usual suspects for causes of edema seem to NOT be the culprit. Her cardiac, renal and liver function studies have all been normal, both with imaging and laboratory results. She has a severe eating disorder and is overtly underweight but the quality of her food intake has always been good and all of her lab work shows a nutritionally 'normal' individual. Unfortunately she recently had a volvulus of the large bowel and required a partial resection and is currently on the mend from that but the bilateral leg edema remains despite diuretics and constant compression stockings. Do you have any brainstorms about the cause of this stubborn edema? It significantly impairs her ambulation and that is never a good thing post surgically, as you know. Thanks for any help

Answered by Dr. Dr. Muhammad Sareer Khalil (2 hours later)

Brief Answer:
Possible other causes present

Detailed Answer:
Hello and Welcome

I appreciate your concern

Yes, immobility can predispose to thrombosis. The most common cause for such a presentation is related to cirrhosis and renal or cardiac dysfunction. But if her Liver function tests are normal with normal liver morphology , ejection fraction is normal with no pulmonary hypertension, renal function tests are normal with no significant proteinuria then one can look for other causes.

Chronic accumulation of edema in lower extremities often indicates venous insufficiency. Deep venous thrombosis should be looked for in this case especially if clinical suspicion is high even though stockings are being advised.

Magnetic resonance venography to look for pelvic/ proximal venous thrombosis or compression can be done to look for patent blood flow in these regions.

Obstructive sleep apnea can also lead to bilateral leg edema and should be looked for. If clinical evidence is there or history is positive for OSA symptoms then sleep studies can be advised.

Previous trauma and radiation therapy can also be possible causes. Allergic conditions and malabsorption should also be looked for.

Wishing you best of health

Thanks

Let me know if you have any query

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Dr. M.S. Khalil

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Dr. Muhammad Sareer Khalil (2 hours later)

Thanks Dr. XXXXXXX I will do my best to 'push' for a MR-venogram of her lower extremities. It sounds like something that could evolve into something more dangerous if we don't rule it out. Not being an MD, I have not too much 'clout' as far as getting tests ordered but I do have a little medical background so maybe that will prompt more urgency on the part of her current physician to at least get THAT test done. The malabsorption idea is an interesting one, although I would have thought that her lab results for general nutrient status would be impacted with any type of absorptive dysfunction? Maybe not ! Anyway I sure appreciate your opinions. Thanks again.

Answered by Dr. Dr. Muhammad Sareer Khalil (17 minutes later)

Brief Answer:
Explained

Detailed Answer:
Hello again

Malabsorption can be assessed via history of diarrhea and manifested effects of the associated deficiencies including skin changes. Serum albumin and total proteins should be checked in this regard, too.

You may apprise your doctor about the above.

Wishing you best of health

Thanks

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Above answer was peer-reviewed by : Dr. Raju A.T