Clinical Evaluation and Management of Lower Extremity Edema Urgent message: The high specificity but broad range of possible causes associated with a primary complaint of lower extremity edema poses a particular challenge to the urgent care clinician. Proper assess- ment of the differential diagnoses is the first step toward optimal outcomes, whether they be facilitated by treatment or referral. Michael S. Miller, DO P Introduction The word circulation is often misused by physicians or w w w. j u c m . c o m misunderstood by patients. While it is usually used in reference to the peripheral blood flow in the arteries, cir- culation more properly refers to the entire course of blood flow from the heart through the peripheral arteries of the distal tissues via the capillar- ies, all the way to its return via the venous system to the heart. Patients may find it easier to grasp the true meaning if you explain that the word it- self was derived from the Latin word circulare—to make a circle. Equally problematic is the diagnosis of “poor circula- tion” made by a simple visual inspection of the legs when, in fact, no arterial compromise exists. Consideration should always include both the arterial and the venous. Arterial circulation can easily be assessed via a well- taken history (“How far can you walk? Does the pain make you stop walking? Do you have to rest—and for © 3D4medical.com atients presenting to ur- gent care with a primary complaint of edema of the lower extremities of any duration can pose a particularly vexing challenge for the practitioner. While the symptom is quite spe- cific, it could be indicative of any number of diagnoses; is the root cause chronic ve- nous insufficiency, or a more emergent condition requir- ing immediate referral (e.g., deep vein thrombosis)? Further, how do you dif- ferentiate between stasis der- matitis and cellulitis, thereby avoiding inappropriate an- tibiotic therapy? Such determinations are essential preparation for choosing appropriate treatment or referring the patient to the appropriate setting for care. JUCM T h e J o u r n a l o f U r g e n t C a r e M e d i c i n e | M a rc h 2 0 0 9 9