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What causes severe edema in the legs without any other signs of injury?

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Posted on Wed, 23 May 2018
Question: Patient: Female, 73 years, 6 months old, 5'7" tall, 230 lbs., in generally good health. Hypertension well controlled with medication, lifelong history of recurring clinical depression. Currently takes medication for depression and hypertension, plus otc antihistamines and occasional NSAIDs. Patient uses a CPAP machine to treat sleep apnea. Patient had a physical exam 1 month ago, with all liver, kidney, and blood values within normal limits. Cholesterol is also within normal limits.
Approximately 100 hours ago, patient tripped on a curbing and fell to the ground. Aside from 2 minor abrasions (nose and forehead), and bumps on both shins, patient was well, got up, walked away without incident. Two hours later, patient drove home (150 miles) in a 30-foot camper.
There was immediate, significant swelling at the site of the bumps on the shins, but no pain on motion or activity. There is no sign of blood under the skin (like a bruise), but edema in both legs continued to increase. By 48 hours, edemas had expanded, including ankles and feet. Left greater than right, but little difference. No pain was noted, except that tight skin is very sensitive, and the pain of edema.
Patient has been drinking lots of water, and has added 40 mg. furosemide at 6 am and 6 pm. She has also been using a warm whirlpool daily.
Question: What could be causing this edema without any other sign of injury?
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Answered by Dr. T Chandrakant (22 minutes later)
Brief Answer:
Elevation of affected limbs above heart level in laying down position.

Detailed Answer:
Hi.
Thanks for your query about a 73 and half year old lady.
Noted the history well and understood the concerns:
The laxity under the skin particularly in the lower limbs increases allowing accumulation of edema even on trivial injuries and since there is spread of the edema one may not find any bruising.
I would advise her the following in such a situation:
Elevation the affected limbs above heart level in laying down position is the best way to reduce the edema by dependent drainage technique. This can be done by elevating with support from thigh to the heels with the level of heels above the heart level.
Complete rest.
Clinical evaluation by a Doctor for probable cause and to see for or rule out other causes by X-rays, ultrasonography of the affected areas and any other tests as may be needed; it is better to rule out other causes by investigations as mentioned and that of blood and urine.

I hope this answers your query and helps further.
Any cold or hot fomentations may not help after such a long time.
Anti-inflammatory medications like Ibuprofen or serratiopeptidase may help for early resolution.
Continue the medical management.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. T Chandrakant

General Surgeon

Practicing since :1984

Answered : 18097 Questions

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What causes severe edema in the legs without any other signs of injury?

Brief Answer: Elevation of affected limbs above heart level in laying down position. Detailed Answer: Hi. Thanks for your query about a 73 and half year old lady. Noted the history well and understood the concerns: The laxity under the skin particularly in the lower limbs increases allowing accumulation of edema even on trivial injuries and since there is spread of the edema one may not find any bruising. I would advise her the following in such a situation: Elevation the affected limbs above heart level in laying down position is the best way to reduce the edema by dependent drainage technique. This can be done by elevating with support from thigh to the heels with the level of heels above the heart level. Complete rest. Clinical evaluation by a Doctor for probable cause and to see for or rule out other causes by X-rays, ultrasonography of the affected areas and any other tests as may be needed; it is better to rule out other causes by investigations as mentioned and that of blood and urine. I hope this answers your query and helps further. Any cold or hot fomentations may not help after such a long time. Anti-inflammatory medications like Ibuprofen or serratiopeptidase may help for early resolution. Continue the medical management.