Differential Diagnosis for Swelling in Feet, Ankles, and Hands
Given the symptoms of swelling in the feet and ankles every evening, despite wearing compression socks, and swelling in the hands during walks, with a negative test for hereditary angioedema, the following differential diagnoses are considered:
Single Most Likely Diagnosis
- Idiopathic Edema: This condition is characterized by swelling that occurs without an identifiable cause, often worsening in the evening and improving with elevation. The fact that compression socks do not prevent the swelling and that it occurs in a predictable pattern (evenings) supports this diagnosis. Idiopathic edema can also be exacerbated by activity, explaining the swelling in hands during walks.
Other Likely Diagnoses
- Chronic Venous Insufficiency: This condition leads to poor blood circulation from the legs back to the heart, causing fluid to accumulate in the legs and ankles, resulting in swelling. It's more common in individuals who stand for long periods or have a history of deep vein thrombosis.
- Lymphedema: A condition where the lymphatic system is impaired, leading to the accumulation of protein-rich fluid in the interstitial tissue, causing swelling. It can be primary (inherited) or secondary (due to surgery, infection, or trauma).
- Hypothyroidism: Although less common, hypothyroidism can cause generalized swelling due to the accumulation of mucopolysaccharides in the skin and other tissues.
Do Not Miss Diagnoses
- Heart Failure: Right-sided heart failure can lead to peripheral edema due to the heart's inability to pump blood effectively, causing fluid buildup in the legs and ankles. Missing this diagnosis could be fatal if not addressed promptly.
- Nephrotic Syndrome: A collection of symptoms indicating kidney damage, including severe swelling (edema), particularly in the face, legs, and feet. It's crucial to diagnose and treat the underlying cause to prevent long-term kidney damage.
- Deep Vein Thrombosis (DVT): Although DVT typically presents with unilateral swelling, pain, and warmth, it's essential to consider it, especially if there's a history of recent immobility, surgery, or cancer. DVT can lead to pulmonary embolism, a potentially life-threatening condition.
Rare Diagnoses
- Sarcoidosis: A disease characterized by the growth of granulomas (inflammatory cells) in various parts of the body, which can lead to swelling in the extremities among other symptoms.
- Amyloidosis: A condition where abnormal proteins (amyloid) accumulate in organs and tissues, potentially causing swelling, among other systemic symptoms.
- Fabry Disease: A rare genetic disorder that can cause swelling in the hands and feet due to the accumulation of a particular type of fat in the body's cells.