Last updated: March 23, 2022

Summarytoggle arrow icon

Edema is an abnormal accumulation of interstitial fluid caused by a variety of conditions, including, for instance, generalized fluid retention and localized reactions to trauma and allergies. Edema may manifest with swelling of the extremities (peripheral edema) or with internal fluid accumulation in organs and body cavities (e.g., pulmonary edema, pleural effusion). Patients with peripheral edema usually present with painless swelling of the lower legs. A residual indentation left by pressure on the site of the swelling indicates pitting edema. Bilateral lower limb pitting edema is often a sign of cardiac failure, while generalized peripheral pitting edema with swelling of the eyelids indicates hypoalbuminemia (e.g., in nephrotic syndrome). Nonpitting edema is seen especially in patients with lymphatic disorders and thyroid conditions.

General featurestoggle arrow icon


Causestoggle arrow icon

Pitting vs. nonpitting edema

Overview of pitting edema vs. nonpitting edema
Pitting edema Nonpitting edema
  • A type of edema characterized by residual indentation following the application of pressure to the site of the swelling
  • A type of edema in which there is no residual indentation following the application of pressure to the site of swelling
Physical examination
  • Application of firm pressure to the edematous tissue for ∼ 5 seconds
  • Pitting edema grading system
    • Grade +1: up to 2 mm of depression, rebounding immediately
    • Grade +2: 3–4 mm of depression, rebounding in ≤ 15 sec
    • Grade +3: 5–6 mm of depression, rebounding in ∼ 60 sec
    • Grade +4: 8 mm of depression, rebounding in ∼ 2–3 min
  • No depression
  • Management of underlying condition

Generalized vs. localized edema

Generalized vs. localized edema
Generalized Localized




Lymphedematoggle arrow icon

  • Definition: edema associated with lymphatic obstruction and reduced fluid clearance due to compromised lymphatic vessels or lymph nodes
    • Lipid-rich, protein-rich fluid in the interstitial space that has high viscosity
  • Etiology
  • Clinical findings
    • Swelling of limbs; characteristically nonpitting edema
    • Swelling of toes and feet with deep flexion creases
    • Stemmer's sign: inability to lift a skin fold on the base of the second toe
  • Stages
  • Treatment
    • Conservative
      • Manual lymphatic drainage (a form of massage that is applied in direction of the heart to increase the natural drainage of lymphatic fluid) and compression garments
      • Elevation of the involved limb
      • Exercise
      • Management of underlying disease
    • Surgical
      • Resection of lymphatic vessels
      • Lymphaticovenous anastomosis and lymphatic vessel grafting
      • Vascularized lymph node transfer

In lymphedema toes are affected, in contrast to venous edema.


Referencestoggle arrow icon

  1. Stems RH. Clinical manifestations and diagnosis of edema in adults. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. Last updated: August 29, 2016. Accessed: February 19, 2017.
  2. Sica D. Calcium channel blocker-related periperal edema: can it be resolved?. J Clin Hypertens (Greenwich). 2003; 5 (4): p.291-294.doi: 10.1111/j.1524-6175.2003.02402.x . | Open in Read by QxMD
  3. Kasper DL, Fauci AS, Hauser SL, Longo DL, Lameson JL, Loscalzo J. Harrison's Principles of Internal Medicine. McGraw-Hill Education ; 2015
  4. Le T, Bhushan V, Chen V, King M. First Aid for the USMLE Step 2 CK. McGraw-Hill Education ; 2015
  5. Daniel MS, Rohena LO. Turner Syndrome. Turner Syndrome. New York, NY: WebMD. Updated: June 17, 2016. Accessed: February 19, 2017.
  6. Goljan EF. Rapid Review Pathology. Elsevier Saunders ; 2018

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