Differential Diagnosis for Acute Left Lower Extremity Swelling

The patient presents with acute onset of left lower extremity swelling, burning, and throbbing, which suggests a vascular or inflammatory cause. The following differential diagnoses are considered:

• Single Most Likely Diagnosis

  • Deep Vein Thrombosis (DVT): The patient's symptoms of acute onset swelling, warmth, and throbbing pain in the left lower extremity are classic for DVT. The patient's history of hypertension, hyperlipidemia, and significant time spent sitting as a medicab driver also increase his risk for DVT.

• Other Likely Diagnoses

  • Cellulitis: The patient's history of prior episode of left lower extremity swelling with drainage of pus, and the current symptoms of warmth and swelling, could suggest cellulitis. However, the lack of fever and the fact that the patient did not improve with antibiotics make this diagnosis less likely.
  • Lymphedema: The patient's significant weight and history of swelling in the left lower extremity could suggest lymphedema. However, the acute onset of symptoms and the presence of warmth and throbbing pain make this diagnosis less likely.
  • Varicose Veins or Venous Insufficiency: The patient's symptoms of swelling and warmth could be related to varicose veins or venous insufficiency, especially given his history of significant time spent sitting.

• Do Not Miss Diagnoses

  • Phlegmasia Cerulea Dolens: This is a rare but life-threatening condition caused by acute venous thrombosis, which can lead to limb ischemia and gangrene. The patient's symptoms of severe swelling, pain, and warmth could suggest this diagnosis.
  • Compartment Syndrome: This is a medical emergency caused by increased pressure within a muscle compartment, which can lead to limb ischemia and necrosis. The patient's symptoms of severe pain and swelling could suggest this diagnosis.
  • Septic Thrombophlebitis: This is a rare but life-threatening condition caused by infection of a venous thrombus, which can lead to sepsis and death. The patient's history of prior episode of left lower extremity swelling with drainage of pus could suggest this diagnosis.

• Rare Diagnoses

  • Lipedema: This is a rare condition characterized by abnormal fat deposition in the lower extremities, which can cause swelling and pain. However, the acute onset of symptoms and the presence of warmth and throbbing pain make this diagnosis less likely.
  • Erythromelalgia: This is a rare condition characterized by burning pain, heat, and redness in the extremities, which can be caused by various underlying conditions. However, the patient's symptoms of swelling and warmth are not typical of this diagnosis.