Physical Exam

Edema Assessment

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Video coming September 2026

How to Perform

Press firmly with a fingertip or thumb over a bony prominence — such as the medial malleolus, the dorsum of the foot, or the shin over the tibia — holding for several seconds, then release. Note whether an indentation (pit) remains, how deep it is, and how long it takes to refill; test the most dependent areas.

How to Interpret

Cirrhosis

Bilateral pitting lower extremity edema

Rule in

Somewhat helpful

Rule out

—

Evidence:Strong

Deep Vein Thrombosis

Unilateral pitting lower extremity edema

Rule in

Not helpful

Rule out

Not helpful

Evidence:Limited

Heart Failure

Bilateral pitting lower extremity edema

Rule in

Somewhat helpful

Rule out

Minimally helpful

Evidence:Strong

References

Wang CS, FitzGerald JM, Schulzer M, Mak E, Ayas NT. Does this dyspneic patient in the emergency department have congestive heart failure? JAMA. 2005;294(15):1944-1956. doi:10.1001/jama.294.15.1944. PMID: 16234501. JAMA Rational Clinical Examination systematic review of 22 studies of adult ED patients with dyspnea. PubMed abstract freely accessible; specific per-finding values widely tabulated in secondary literature. Verified via DARE NBK71447 (NCBI Bookshelf, Centre for Reviews and Dissemination quality-assessed entry, open access) during BedsideDx Scope B audit cascade #38 (2026-05-14): DARE summary reproduces Wang 2005 per-feature pooled LR values exactly. CRD commentary: methods 'appropriate'; conclusions 'likely to be reliable'; two CRD-noted limitations are (i) MEDLINE-only English-only search may have missed relevant studies and (ii) heterogeneity not formally assessed. Neither limitation challenges the headline per-feature pooled LRs.
Udell JA, Wang CS, Tinmouth J, FitzGerald JM, Ayas NT, Simel DL, Schulzer M, Mak E, Yoshida EM. Does this patient with liver disease have cirrhosis? JAMA. 2012 Feb 22;307(8):832-842. doi:10.1001/jama.2012.186. PMID: 22357834.
Goodacre S, Sutton AJ, Sampson FC. Meta-analysis: the value of clinical assessment in the diagnosis of deep venous thrombosis. Ann Intern Med. 2005;143(2):129-139. doi:10.7326/0003-4819-143-2-200507190-00012. PMID: 16027455. Free article (Annals of Internal Medicine). DARE quality-assessed summary at NCBI Bookshelf NBK71906 (Centre for Reviews and Dissemination): CRD commentary rates methods as adequate and conclusions as reliable. Independently verified during BedsideDx Scope B audit cascade #36 (2026-05-14): all 13 per-feature pooled LRs and CIs reproduced in DARE summary match the original publication; oedema-specific values confirmed (LR+ 1.35 [CI 1.05-1.74], LR- 0.86 [CI 0.79-0.94]).
McGee S. Evidence-Based Physical Diagnosis. 6th ed. Philadelphia, PA: Elsevier; 2025.