ArticleClinical case reports2026
Not All Leg Swelling Is Volume Overload: Point-of-Care Ultrasound and Sirolimus-Associated Lymphedema After Combined Heart-Kidney Transplant.
Article in Clinical case reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
A 65-year-old man, one year post combined heart-kidney transplant, presented with acute kidney injury, dyspnea, and progressive leg edema unresponsive to escalating diuretics. Despite suspicion for volume overload, multi-organ point-of-care ultrasound (POCUS) revealed bilateral A-lines without B-lines or effusions, a small collapsible inferior vena cava, and preserved biventricular function, all inconsistent with cardiogenic congestion. The edema was attributed to sirolimus-associated lymphedema. Diuretic cessation and transition from sirolimus to everolimus improved renal function. This case illustrates the utility of integrated multi-organ POCUS in challenging assumptions about volume status and underscores the importance of contextualizing findings across multiple sonographic windows.
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