Differential Diagnosis for 68 y/o Female Smoker with Bilateral Peripheral Edema

Single Most Likely Diagnosis

• Chronic Venous Insufficiency: This condition is common in smokers and can cause bilateral peripheral edema due to the incompetence of venous valves, leading to fluid accumulation in the lower limbs.

Other Likely Diagnoses

• Heart Failure: Smoking is a risk factor for heart disease, and heart failure can cause peripheral edema due to fluid overload and decreased cardiac output.
• Chronic Obstructive Pulmonary Disease (COPD) with Cor Pulmonale: COPD is common in smokers, and cor pulmonale (right-sided heart failure) can lead to peripheral edema.
• Nephrotic Syndrome: Although less common, nephrotic syndrome can cause significant protein loss, leading to hypoalbuminemia and subsequent peripheral edema.

Do Not Miss Diagnoses

• Deep Vein Thrombosis (DVT): Although less likely, DVT can cause unilateral or bilateral peripheral edema and is a medical emergency due to the risk of pulmonary embolism.
• Lymphoma or Other Malignancies: Certain cancers can cause peripheral edema, either directly or through lymphatic obstruction, and are critical to diagnose early.
• Thyroid Disease: Both hypothyroidism and hyperthyroidism can cause peripheral edema, although this is less common.

Rare Diagnoses

• Lipedema: A rare condition characterized by the abnormal growth of fat cells in the lower limbs, leading to peripheral edema.
• Sarcoidosis: A systemic disease that can cause peripheral edema, although this is an uncommon presentation.
• Fabry Disease: A rare genetic disorder that can cause peripheral edema, among other symptoms, due to the accumulation of globotriaosylceramide in various tissues.