Differential Diagnosis for 78-year-old with Worsening Purple Discoloration to BLE
- Single most likely diagnosis
- Peripheral Arterial Disease (PAD): The patient's symptoms of worsening purple discoloration, pain during ambulation, cool skin, and poor capillary refill with diminished pedal pulses are highly suggestive of PAD. The 2+ pitting edema may be secondary to chronic venous insufficiency or heart failure, but in the context of these other symptoms, PAD is the most likely primary diagnosis.
- Other Likely diagnoses
- Chronic Venous Insufficiency (CVI): While the patient's symptoms could be partially attributed to CVI, the presence of pain during ambulation and poor capillary refill suggests an arterial component. However, CVI could be a contributing factor to the edema and skin discoloration.
- Deep Vein Thrombosis (DVT): DVT could cause pain, edema, and skin discoloration, but the patient's symptoms of cool skin and poor capillary refill are more suggestive of an arterial issue.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Acute Limb Ischemia (ALI): Although the patient's symptoms have been worsening, it's crucial to consider ALI, which is a medical emergency. ALI can present with the "6 Ps": pain, pallor, pulselessness, poikilothermia, paresthesia, and paralysis. The patient's symptoms of pain, cool skin, and poor capillary refill warrant consideration of ALI.
- Embolic Event: An embolic event, such as a pulmonary embolism or an embolus to the lower extremity, could cause sudden worsening of symptoms. While less likely, it's essential to consider this possibility due to its high mortality rate if left untreated.
- Rare diagnoses
- Buerger's Disease (Thromboangiitis Obliterans): This rare disease causes inflammation and thrombosis of blood vessels, leading to ischemia. It typically affects younger smokers, but it's essential to consider it in the differential diagnosis due to its potential for severe consequences if left untreated.
- Vasculitis: Various forms of vasculitis, such as giant cell arteritis or polyarteritis nodosa, can cause ischemic symptoms. However, these conditions are relatively rare and would typically be accompanied by other systemic symptoms.