Differential Diagnosis for 83 y/o Female with Swelling in Ankle after Aortic Valve Replacement and Plavix

• Single Most Likely Diagnosis
  • Edema due to Plavix (clopidogrel) therapy: Plavix is known to cause edema in some patients, and the timing of the swelling after starting Plavix suggests a possible causal relationship.
• Other Likely Diagnoses
  • Deep Vein Thrombosis (DVT): Although the patient is on Plavix, which is an antiplatelet agent, the risk of DVT cannot be entirely ruled out, especially in an elderly patient with a history of recent surgery.
  • Heart Failure: The patient's history of aortic valve replacement suggests potential cardiac complications, including heart failure, which could lead to peripheral edema.
  • Peripheral Artery Disease (PAD): PAD could cause swelling and pain in the ankle, especially if the patient has a history of atherosclerosis.
• Do Not Miss Diagnoses
  • Pulmonary Embolism (PE): Although less likely, PE is a potentially life-threatening condition that could present with leg swelling and should not be missed.
  • Cellulitis or Infection: Infection of the skin and soft tissues could cause swelling, redness, and warmth in the affected area, and prompt treatment is necessary to prevent serious complications.
  • Complications of Aortic Valve Replacement: Rare but serious complications such as prosthetic valve thrombosis or endocarditis could present with non-specific symptoms, including swelling.
• Rare Diagnoses
  • Lymphedema: This condition involves the abnormal collection of protein-rich fluid in the interstitial tissue, leading to swelling, and could be a rare cause of ankle swelling in this patient.
  • Vasculitis: Inflammation of the blood vessels could cause swelling, pain, and other symptoms in the affected area, but this would be an uncommon diagnosis in this context.