Question 244

Question:

A 50-year-old woman with a history of ovarian cancer comes to the physician’s office because of swelling in her right leg for the past month. Examination shows edema in the right lower extremity. Which of the following is the most likely cause of the edema?

Correct Answer: E.  Obstruction of lymph vessels

In this patient with a history of ovarian cancer, the most likely cause of her edema is (E) obstruction of lymph vessels secondary to her malignancy. While various clinical conditions can cause edema, including congestive heart failure, cirrhosis, and nephrotic syndrome, these disorders are typically associated with pitting edema. This patient presents with nonpitting lymphedema, characterized by its involvement of an isolated limb.

(A) Decreased capillary hydrostatic pressure would not cause edema, although increased capillary hydrostatic pressure would.

(B) Decreased interstitial hydrostatic pressure is unlikely.

(C) Increased capillary oncotic pressure would not cause edema, although decreased capillary oncotic pressure would.

(D) Increased capillary permeability, as in seen in burns, trauma, inflammation, sepsis, and allergic reactions, may cause edema. However, this presentation makes lymphedema much more likely.