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Pitting and non-pitting oedema

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The distinction is essential to determine aetiology and treatment

Oedema can be divided into two types: pitting and non-pitting. These types are relatively easy to distinguish clinically and the distinction is essential to determine aetiology and treatment.

Oedema is the swelling of soft tissue due to fluid accumulation. Pitting is demonstrated when pressure is applied to the oedematous area and an indentation remains in the soft tissue after the pressure is removed (Box 1 and Box 2). Moreover, mild pitting oedema is best identified by applying pressure over an area of bony prominence. Non-pitting oedema refers to the lack of persistent indentation in the oedematous soft tissue when pressure is removed.1

In addition to the differentiation of pitting and non-pitting oedema, the pattern of distribution is reflective of the underlying aetiology. With pitting oedema, there may be bilateral dependent oedema of the lower limbs, generalised oedema or localised oedema. Non-pitting oedema generally affects an isolated area, such as a limb. There are two ways of describing the severity of pitting oedema. Most commonly, in the setting of peripheral oedema, severity is graded by its proximal extent, so that oedema located above the knee is more severe than oedema presenting below the knee. The alternative approach is based on depth…