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Despite suspicion for volume overload, multi\u2010organ point\u2010of\u2010care ultrasound (POCUS) revealed bilateral A\u2010lines without B\u2010lines or effusions, a small collapsible inferior vena cava, and preserved biventricular function, all inconsistent with cardiogenic congestion. The edema was attributed to sirolimus\u2010associated lymphedema. Diuretic cessation and transition from sirolimus to everolimus improved renal function. This case illustrates the utility of integrated multi\u2010organ POCUS in challenging assumptions about volume status and underscores the importance of contextualizing findings across multiple sonographic windows.<\/jats:p>","DOI":"10.1002\/ccr3.72717","type":"journal-article","created":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T03:44:57Z","timestamp":1778816697000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Not All Leg Swelling Is Volume Overload: Point\u2010of\u2010Care Ultrasound and Sirolimus\u2010Associated Lymphedema After Combined Heart\u2010Kidney Transplant"],"prefix":"10.1002","volume":"14","author":[{"given":"Rebecca","family":"Boyle","sequence":"first","affiliation":[{"name":"Stanford Hospital and Clinics, Department of Nephrology  Palo Alto California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5040-6218","authenticated-orcid":false,"given":"Neev","family":"Patel","sequence":"additional","affiliation":[{"name":"Stanford University, Department of Nephrology  Palo Alto California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,14]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/acem.12878"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.07\u20102800"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMvcm2108203"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.3310\/hta13320"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/0735\u20101097(93)90405\u2010p"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.3389\/fcvm.2022.918051"},{"issue":"6","key":"e_1_2_13_8_1","doi-asserted-by":"crossref","first-page":"884","DOI":"10.1001\/jama.1989.03420060100040","article-title":"The Limited Reliability of Physical Signs for Estimating Hemodynamics in Chronic Heart Failure","volume":"261","author":"Stevenson L. 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