Hematology – Localized Edema: By Maja Artandi M.D.

Localized edema, especially in the extremities,
can be due to harmless causes or can potentially result in life threatening complications. It is important that you make the right diagnosis,
because not treating a serious condition can be fatal for the patient. Localized edema is most frequently found in
the extremities, but can also be seen elsewhere, for example in the face. The most common reasons for localized edema
are venous problems such as a deep venous thrombosis, cellulitis and a Baker’s cyst. When somebody presents with unilateral swelling
of one extremity, it is extremely important to rule out a blood clot in the deep venous
system. A patient with a thrombus in the deep venous
system has a high risk of developing a pulmonary embolus, a potentially lethal condition. The history and physical examination of the
patient are crucial to raise the suspicion for a thrombosis. A patient has a higher likelihood of having
a blood clot when he or she has not moved for a long time, for example after surgery
or long airplane flights or has a condition that increases the risk for venous thrombosis,
such as clotting disorders or cancer. Pregnancy and certain medications can also
increase the risk for a blood clot. The most important clinical findings in a
patient with a deep venous thrombosis are swelling and pain. Unfortunately, though, the physical findings
are neither sensitive nor specific for diagnosing a blood clot as other causes for localized
edema can present the same way. To assist in the accuracy of diagnosing a
blood clot the Well’s score was developed. Points are given for findings in the history
and physical exam known to be associated with a deep venous blood clot. Based on the score, patients are stratified
into low, moderate and high probability for a deep venous thrombosis. Another helpful test to evaluate patients
is a blood test, called the D-Dimer. If the Wells score is low and the patient
has a negative D-Dimer it can be safely assumed that the localized swelling is not due to
a DVT and no further testing to rule out a blood clot needs to be done. However, if the clinical probability is high
and the patient has a positive D-Dimer further testing, for example with a Doppler Ultrasound,
should be done. If the patient has a confirmed blood clot,
therapy with anticoagulation must be initiated to prevent complications.

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