pittingÖdeme

Pitting edema, or pitting ödem in Turkish usage, is a form of swelling in which pressing on the swollen area with a finger leaves a temporary indentation or pit. The pit reflects excess interstitial fluid in the subcutaneous tissues. The indentation typically persists briefly, and its depth is used to grade severity, commonly from 1+ to 4+.

Common causes include congestive heart failure, liver cirrhosis with hypoalbuminemia, nephrotic syndrome, venous insufficiency or obstruction, pregnancy, and medications such as calcium channel blockers, nonsteroidal anti-inflammatory drugs, and thiazolidinediones. Less often, edema results from malnutrition, renal failure, or inflammatory conditions. Lymphedema may be non-pitting, so the presence of a true pit helps narrow the differential.

Pathophysiology generally involves increased capillary hydrostatic pressure, decreased plasma oncotic pressure, lymphatic obstruction, or sodium and water retention. Systemic diseases (heart, liver, kidney) often produce symmetric, bilateral edema, most noticeable in the lower limbs, while localized edema may suggest venous or lymphatic problems.

Clinical features include swelling in the legs and feet, especially at the end of the day, with a positive pitting test. Patients may report weight gain, abdominal distension if ascites is present, or shortness of breath with cardiac involvement. A DVT should be considered if edema is unilateral, warm, or tender.

Diagnosis combines history, physical examination, and targeted tests such as albumin and kidney/liver function, BNP or echocardiography if heart failure is suspected, and Doppler ultrasound to exclude venous thrombosis. Management focuses on treating the underlying cause, diuretics for volume overload, reduced sodium intake, leg elevation, and compression therapy as appropriate.