ETIOLOGY AND DIAGNOSIS OF BILATERAL LEG EDEMA IN PRIMARY-CARE

PURPOSE: To identify the causes of bilateral leg edema in a primary ca re setting, and to determine the ability of primary care providers to arrive at the correct diagnosis using the information available at the initial clinical encounter. PATIENTS AND METHODS: Fifty-eight ambulat ory adult patients with bilateral leg edema were enrolled at an inner city family practice during a 3-year period. Historical information, p hysical examination findings, and clinical impressions of primary care providers were compared with the results of laboratory evaluations co nsisting of echocardiograms, venous duplex ultrasound leg scans, serum albumin levels, and when appropriate, 24-hour urinalyses. RESULTS: Fo rty-five patients (78%) completed the study. The initial clinical impr ession was venous insufficiency in 32 (71%) patients and congestive he art failure in 8 (18%) patients. In actuality, 15 (33%) patients had a cardiac condition as a cause of their leg edema, and 19 (42%) had pul monary hypertension. All of the patients with heart disease, and almos t all of those with pulmonary hypertension, were age 45 years or older . Only 10 (22%) of the subjects had venous insufficiency. Renal condit ions, medication use, and hyponlbuminemia were less common. CONCLUSION S: Utilizing clinical information only, many patients with cardiopulmo nary pathology were incorrectly diagnosed as having more benign condit ions, most commonly venous insufficiency. Echocardiographic evaluation , including an estimation of pulmonary artery pressure, maybe advisabl e in many patients with bilateral leg edema, especially if they are at least 45 years old. (C) 1998 by Excerpta Medica, Inc.