Differential Diagnosis
The patient's symptoms suggest a complex interplay of vascular, musculoskeletal, and possibly cardiac issues. Here's a categorized differential diagnosis:
Single most likely diagnosis
- Chronic Venous Insufficiency (CVI): The description of the vein across the thigh, non-pitting swelling, and pain exacerbated by squatting could indicate CVI. The condition often presents with varicose veins, swelling, and pain in the affected limb. Mitral valve prolapse might be an incidental finding, but it could also contribute to overall cardiovascular health. Pain during/after sex could be related to pelvic congestion syndrome, which can coexist with CVI.
Other Likely diagnoses
- Pelvic Congestion Syndrome: This condition involves varicose veins in the pelvic region, which could cause pain during/after sex and contribute to lower back pain. It often coexists with CVI and could explain some of the patient's symptoms.
- Lymphedema: Although the swelling is described as non-pitting, lymphedema could still be considered, especially if the patient has a history of surgery, radiation, or infection in the affected limb.
- Varicose Veins with Superficial Thrombophlebitis: The visible vein across the thigh could be a varicose vein, and the patient's symptoms might be exacerbated by superficial thrombophlebitis.
Do Not Miss
- Deep Vein Thrombosis (DVT): Although the swelling is non-pitting, DVT should be ruled out due to the potential for severe complications, such as pulmonary embolism.
- Ovarian Torsion or Other Gynecologic Emergencies: Severe pain during/after sex could indicate a gynecologic emergency, such as ovarian torsion, which requires prompt attention.
- Spinal Stenosis or Herniated Disk: The patient's lower back pain, exacerbated by squatting, could be related to spinal stenosis or a herniated disk, which might compress nerves and cause leg symptoms.
Rare diagnoses
- Klippel-Trenaunay Syndrome: This rare condition involves congenital vascular malformations, which could explain the patient's symptoms, including the visible vein and swelling.
- Parkes Weber Syndrome: Another rare condition, characterized by congenital vascular malformations, which might contribute to the patient's symptoms.
- May-Thurner Syndrome: A rare condition involving compression of the left common iliac vein, which could cause CVI-like symptoms in the left leg. However, the patient's symptoms are described in the right leg.