Graduate School of Human Nursing,The University of Shiga Prefecture, Shiga, 522-8533, JapanJapan
Department of Women’s Health, Graduate School of Human Nursing,The University of Shiga Prefecture, Shiga, 522-8533, JapanJapan
School of Nursing,Tsuruga Nursing University, Fukui, 914-0814, JapanJapan
School of Engineering, Department of Electronic Systems Engineering,The University of Shiga Prefecture, Shiga, 522-8533, JapanJapan
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Peripheral edema is the swelling of lower legs or hands. Venous edema, which differs from lymphedema, occurs when something disrupts the usual balance of body fluids1 and involves the accumulation of fluid in the extracellular compartment, which results in an increase in the volume of interstitial fluid.2 Physiologically, a balance exists between intravascular hydrostatic and oncotic pressures and the interstitial pressure.3 Transcapillary hydrostatic pressure tends to drain fluid from blood vessels, whereas oncotic pressure (hypoalbuminemia) tends to produce fluid retention in blood vessels. Venous edema consists of excess low-viscosity, protein-poor interstitial fluid resulting from increased capillary filtration that cannot be accommodated by a normal lymphatic system.4 Thus, fluid movement occurs from the venous system into the extravascular space. Initially, gravity pulls the fluid down into both legs and feet.
Keywords: heart failure, preeclampsia, cirrhosis, pulmonary hypertension, and renal failure
OpenJournal PUBLISHERS Commentary Evaluation of Female Leg Edema Through Ultrasonography 1 2 3 1 Eri Ikuta, RN, MA1;Yumiko Watanabe, CNM, MA2; Nami Yanagisawa, CNM, MA3; Miwa Nakagawa, RN, MA1; 1 1 1 2* Ayumi Ono, RN, MA ; Keiko Seki, CNM, MA ; Makiko Oowaki, CNM,PhD ; Masafumi Koshiyama, MD,PhD ; Shin-ichi Sakamoto, Dr Eng4 1Graduate School of Human Nursing,The University of Shiga Prefecture, Shiga, 522-8533, Japan 2Department of Women’s Health, Graduate School of Human Nursing,The University of Shiga Prefecture, Shiga, 522-8533, Japan 3School of Nursing,Tsuruga Nursing University, Fukui, 914-0814, Japan 4School of Engineering, Department of Electronic Systems Engineering,The University of Shiga Prefecture, Shiga, 522-8533, Japan * *Corresponding authors Masafumi Koshiyama, MD, PhD Professor, Department of Women’s Health, Graduate School of Human Nursing,The University of Shiga Prefecture, Shiga, 522-8533, Japan;Tel +81-749-28-8664; Fax +81-749-28-9532; E-mail: koshiyamam@nifty.com Article information th th Accepted: May 11th, 2024; Published: May 20th, 2024 Cite this article Ikuta E,Watanabe Y,Yanagisawa N, et al. Measurement of women’s leg edema using ultrasonography. Women Health Open J. 2024; 10(1): 5-7. eripheral edema is the swelling of lower legs or hands. Ve- quantitative method to measure leg edema.
nous edema, which differs from lymphedema, occurs when P 1 something disrupts the usual balance of body fluids and involves Ultrasonography is a quantitative imaging method that the accumulation of fluid in the extracellular compartment, which is easy to use and produces consistent results between operators. results in an increase in the volume of interstitial fluid.2 Physiologi- Furthermore, when using a portable ultrasound device, a doctor cally, a balance exists between intravascular hydrostatic and oncotic or nurse can perform this imaging method easily in an outpatient pressures and the interstitial pressure.3 Transcapillary hydrostatic setting. In particular, this approach will also prove useful for the pressure tends to drain fluid from blood vessels, whereas oncot- assessment of the effects of treatments for leg edema. ic pressure (hypoalbuminemia) tends to produce fluid retention in blood vessels. Venous edema consists of excess low-viscosity, Several attempts to observe skin edema using ultrasonog- protein-poor interstitial fluid resulting from increased capillary fil- raphy have been made.
tration that cannot be accommodated by a normal lymphatic sys- tem.4 Thus, fluid movement occurs from the venous system into In gravity dependent edema, the echogenicity on ultraso- the extravascular space. Initially, gravity pulls the fluid down into nography was reported to be higher in the lower leg than in the up- both legs and feet.
per leg, without a marked difference between the medial and lateral sides.6 In addition, the subcutaneous echogenicity of chronically Leg edema can occur under both normal and disease con- edematous legs prior to sleep was reported to be higher than that ditions. Under normal conditions, it occurs in cases of sitting or of reduced legs in the early morning.7 standing too long, pregnancy, excessive salt intake, and drug reac- tions-, just to name a few. Under disease conditions, it occurs in Using high-frequency ultrasound, Volikova et al measured cases of venous insufficiency, deep vein thrombosis (DVT), heart the dermal thickness (between the surface of the epidermis and the failure, preeclampsia, cirrhosis, pulmonary hypertension, and renal interface of the dermis) of the legs of patients with a history of failure, among others.5 previous DVT and symptoms of post-thrombotic syndrome (PTS) and age-matched healthy controls.8 The median dermal thickness Pitting edema is a characteristic of leg edema, and is de- in the control group was 1.34 mm, while that in the PTS group tected when pressure that is applied to the skin leaves a depres- without ulceration was 2.16 mm (p<0.001), with the PTS group sion when removed. This method of detection of leg edema is a showing thicker skin than the control group.
qualitative diagnostic method performed. In brief, there is not a cc cc Copyright 2024 by Koshiyama M. This is an open-access article distributed under Creative Commons Attribution 4.0 International License (CC BY 4.0), which Women Health Open J. 2024; 10(1): 5-7.
Ciggiati reported the ultrasonographic findings of skin measuring the volume of fluid that accumulates in the leg’s skin changes in legs with chronic venous disease.9 In apparently normal layer and carefully monitor cases of lower limb skin edema while skin of C2 class (varicose vein) according to of the clinical-eti- providing early treatment.
ology-anatomy-pathophysiology (CEAP) classification, the main ultrasonographic findings were a normal skin appearance, dermal CONFLICTS OF INTEREST edema or inflammatory infiltration of the cutaneous layer and/ or of the subcutaneous layer. In C3 class (edema) of the CEAP The authors declare that they have no conflicts of interest. classification, by contrast, the findings were homogeneous subcu- taneous thickening, presence of anechoic lacunae and presence of