Differential Diagnosis
The patient's symptoms suggest a vascular issue, particularly affecting the lower extremities. Here's a breakdown of the differential diagnosis:
- Single most likely diagnosis
- Peripheral Arterial Disease (PAD): The reduced pulses in the popliteal, dorsalis pedis, and posterior tibial arteries, along with the delayed digital capillary perfusion, suggest significant arterial insufficiency. The integument changes, such as erythema, thin skin, and absent hair growth, are also consistent with PAD.
- Other Likely diagnoses
- Diabetes Mellitus with Peripheral Vascular Disease: The presence of dry, fissured heels and rough, scaly plantar skin could indicate diabetic foot changes. Diabetes is a common cause of peripheral vascular disease, which would explain the patient's symptoms.
- Chronic Venous Insufficiency: While the primary issue appears to be arterial, chronic venous insufficiency could contribute to the integument changes and edema, potentially exacerbating the patient's symptoms.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Aortic Occlusion or Dissection: Although less likely, aortic occlusion or dissection could cause severe bilateral lower extremity ischemia, leading to the patient's symptoms. This condition is a medical emergency requiring prompt intervention.
- Embolic Event: An embolic event, such as a pulmonary embolism or a cardiac embolism, could cause sudden onset 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 small and medium-sized blood vessels, leading to ischemia. It typically affects younger smokers and could explain the patient's symptoms.
- Ehlers-Danlos Syndrome: This genetic disorder affects connective tissue and can cause vascular fragility, leading to aneurysms, dissections, or occlusions. Although rare, it's essential to consider this diagnosis in patients with unexplained vascular symptoms.