Localized edema

Rationale

Localized expansion of interstitial fluid volume can be caused by serious diseases, and is a common cause of patient concern.

Causal Conditions

(list not exhaustive)

1. Venous insufficiency (including postphlebitic syndrome)
2. Deep venous thrombosis (DVT)
3. Trauma
4. Lymphedema (e.g., malignancy, primary)
5. Infection (cellulitis/soft tissue/bone)
6. Inflammation (e.g., ruptured Baker cyst, chronic dermatitis)

Key Objectives

Given a patient with localized edema, the candidate will diagnose the cause, severity, and complications, and will initiate an appropriate management plan. In particular, diagnosis of proximal deep venous thrombosis must be considered.

Enabling Objectives

Given a patient with localized edema, the candidate will

1. list and interpret critical clinical findings, including
   1. elicit history of risk factors for DVT;
   2. examine extremity for signs associated with specific causes (e.g., palpable clot, tenderness);
   3. in the case of suspected DVT, classify the patient into a pretest probability category (e.g., Wells criteria);
2. list and interpret critical investigations (e.g., d-Dimer, duplex ultrasonography)
3. construct an effective initial management plan, including
   1. outline the management of DVT including under circumstances where same-day diagnostic testing may be unavailable;
   2. list indications and complications, and explain management and monitoring of anti-coagulant therapy;
   3. counsel the patient about anticoagulant therapy (prevention of postphlebitic syndrome);
   4. investigation of causes of DVT, if indicated (e.g., thrombophilic states, underlying cancer);
   5. outline the management of cellulitis;
   6. determine if the patient requires specialized care.