Page 24 - Clinical Pearls in Cardiology

12 Clinical Pearls in Cardiology

18. What do you understand by the terms ‘pitting’ and
‘non-pitting’ with respect to edema?
The cardinal sign of subcutaneous edema is pitting of
the skin. Pitting can be demonstrated by applying firm
pressure for about 60 seconds to the posterior malleolar
space behind the medial malleolus with the thumb. After
removing the finger, a pit will be evident at the point of
application of pressure and this pit will gradually refill.
Very minimal edema can be demonstrated by pressing
with at least three fingers spread slightly apart and then
by feeling for ‘the hills in between the valleys’ created
by the finger (Fig. 3).

Fig. 3: Demonstration of pitting edema
However, edema due to myxedema and chronic
lymphedema do not pit on applying pressure (hence
called as nonpitting edema). The inability to pinch up a
fold of skin on the dorsum of the foot at the base of the
second toe is a sign of lymphedema (called as Kaposi–
Stemmer sign).