Differential Diagnosis for Post-Op Pain in a 76-Year-Old Male
Single Most Likely Diagnosis
- Surgical site hematoma or seroma: Given the patient's recent thrombectomy and the presence of hardening around the surgical site, a hematoma or seroma is a plausible explanation for the post-op pain. The patient's reports of pain when walking and the physical assessment findings support this diagnosis.
Other Likely Diagnoses
- Deep vein thrombosis (DVT): Although the patient is on Eliquis, DVT is still a possible complication, especially given the patient's recent surgery and history of PE. The hardening around the surgical site could be related to a DVT.
- Wound infection: Despite the lack of signs of infection, such as fever or purulent discharge, wound infection is still a possible diagnosis, especially if the patient has not been taking his prescribed pain medication (Tylenol) and has been experiencing pain.
- Pulmonary embolism (PE) recurrence: Given the patient's history of PE and recent surgery, a recurrence of PE is possible, although the chest X-ray suggests pneumonia rather than PE.
Do Not Miss Diagnoses
- Bleeding or hemorrhage: Although the patient denies bleeding, it is essential to consider the possibility of internal bleeding, especially given the patient's anticoagulation therapy (Eliquis). A bleeding complication could be life-threatening if not promptly addressed.
- Sepsis: Although the patient denies fever, chills, or other signs of sepsis, it is crucial to consider this diagnosis, especially if the patient has a wound infection or pneumonia. Sepsis can be life-threatening if not promptly treated.
Rare Diagnoses
- Compartment syndrome: This is a rare but possible complication of surgery, especially if the patient has a hematoma or other swelling in the affected limb. Compartment syndrome can lead to serious complications, including nerve damage and limb loss, if not promptly treated.
- Nerve injury: The patient's reports of pain when walking and hardening around the surgical site could be related to a nerve injury, although this is a less likely diagnosis. Nerve injuries can be challenging to diagnose and treat, and prompt recognition is essential to prevent long-term complications.