Clinical investigations from the RACP

Clinical approach to the patient with peripheral oedema

Craig Juergens, Patrick Diu



Peripheral oedema is a nonspecific clinical sign commonly seen in a wide range of diseases. A systematic approach allows accurate diagnosis and appropriate treatment of the causes of peripheral oedema.

Key Points

  • Causes of peripheral oedema range from the benign to the potentially life-threatening.
  • The distribution of oedema is an important clue to the underlying cause.
  • Unilateral leg swelling usually suggests a local disease process, whereas bilateral peripheral oedema is often due to a systemic cause.
  • Patients with acute unilateral leg oedema should be evaluated for deep vein thrombosis.
  • Diagnostic tests for peripheral oedema aim to rule out significant systemic disease such as heart, liver or kidney failure.
  • Drug-related oedema is relatively common with the use of calcium channel blockers and NSAIDs. Glitazones can cause fluid retention and may precipitate heart failure.
  • Poor compliance with medications and fluid restriction are common causes of hospital admissions of patients with heart failure.