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, dorsum of the foot, or shin over the tibia, and hold for several seconds before releasing. Note whether an indentation (pit) remains, how deep it is, and how long it persists.

How to Interpret

Ascites

Peripheral edema

Rule in

Somewhat helpfulNo CI

Rule out

HelpfulNo CI

Evidence:Limited

Cirrhosis

Bilateral pitting lower extremity edema

Rule in

Somewhat helpfulDerived CI

Rule out

Not helpfulDerived CI

Evidence:Strong

Deep Vein Thrombosis

Unilateral pitting lower extremity edema

Rule in

Not helpful

Rule out

Not helpful

Evidence:Strong

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.
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.
Raff AB, Weng QY, Cohen JM, Gunasekera N, Okhovat JP, Vedak P, Joyce C, Kroshinsky D, Mostaghimi A. A predictive model for diagnosis of lower extremity cellulitis: a cross-sectional study. J Am Acad Dermatol. 2017;76(4):618-625.e2. doi:10.1016/j.jaad.2016.12.044. PMID 28215446.
Pilatis ND, Jacobs LE, Rerkpattanapipat P, Kotler MN, Owen A, Manzarbeitia C, Reich D, Rothstein K, Munoz SJ. Clinical predictors of pulmonary hypertension in patients undergoing liver transplant evaluation. Liver Transpl. 2000;6(1):85-91. PMID: 10648583.
Fernando SM, Tran A, Cheng W, Rochwerg B, Kyeremanteng K, Seely AJE, Inaba K, Perry JJ. Necrotizing Soft Tissue Infection: Diagnostic Accuracy of Physical Examination, Imaging, and LRINEC Score: A Systematic Review and Meta-Analysis. Ann Surg. 2019;269(1):58-65. PMID: 29672405. doi:10.1097/SLA.0000000000002774.
Kori SH, Foley KM, Posner JB. Brachial plexus lesions in patients with cancer: 100 cases. Neurology. 1981;31(1):45-50. PMID: 6256684.
Williams JW Jr, Simel DL. The rational clinical examination. Does this patient have ascites? How to divine fluid in the abdomen. JAMA. 1992;267(19):2645-2648. PMID: 1573754. (Peripheral-edema row traces to Simel DL, Halvorsen RA Jr, Feussner JR. Quantitating bedside diagnosis: clinical evaluation of ascites. J Gen Intern Med. 1988;3(5):423-428. doi:10.1007/BF02595917. PMID: 3049966.)
Ross EJ, Linch DC. Cushing's syndrome—killing disease: discriminatory value of signs and symptoms aiding early diagnosis. Lancet. 1982;2(8299):646-649. doi:10.1016/S0140-6736(82)92749-0. PMID: 6125785.
McGee S. Evidence-Based Physical Diagnosis. 6th ed. Philadelphia, PA: Elsevier; 2025.

Research last updated September 10, 2026.