Differential Diagnosis for a 55-year-old Male with Acute Onset of Right Hand and Leg Swelling, Feeling "Choked Up," and Nausea

• Single Most Likely Diagnosis

  • Deep Vein Thrombosis (DVT): The acute onset of swelling in one limb, particularly when accompanied by a feeling of being "choked up" (which could imply shortness of breath or chest discomfort) and nausea, suggests a possible DVT. This condition is a blood clot that forms in a vein deep inside your body and can lead to pulmonary embolism if the clot breaks loose.

• Other Likely Diagnoses

  • Cellulitis: An infection of the skin and subcutaneous tissues that could cause swelling, redness, and warmth of the affected limb. However, it typically presents with fever and localized signs of infection.
  • Lymphedema: Swelling caused by impaired lymph drainage, but it usually develops more gradually and is often bilateral.
  • Peripheral Artery Disease (PAD): Although PAD typically presents with intermittent claudication (pain in the legs when walking), acute limb ischemia could present with sudden swelling and pain, but usually, there's a history of similar episodes.

• Do Not Miss Diagnoses

  • Pulmonary Embolism (PE): A life-threatening condition that can present with sudden onset of shortness of breath, chest pain, and possibly limb swelling if there's associated DVT. The feeling of being "choked up" could be indicative of a PE.
  • Acute Limb Ischemia: A sudden decrease in limb perfusion that can cause pain, pallor, pulselessness, poikilothermia, paresthesias, and paralysis. It's an emergency requiring immediate intervention.
  • Compartment Syndrome: A condition resulting from increased pressure within a muscle compartment, leading to muscle and nerve damage. It presents with the 5 Ps: pain, pallor, pulselessness, paresthesia, and paralysis.

• Rare Diagnoses

  • Superior Vena Cava Syndrome: Obstruction of the superior vena cava, which can cause swelling of the face, neck, and upper limbs, but it's less likely given the specific involvement of the right hand and leg.
  • Venous Thoracic Outlet Syndrome: Compression of the subclavian vein, which could cause swelling of the arm, but it's less common and usually associated with specific activities or postures.
  • Erythromelalgia: A disorder characterized by burning pain, heat, and redness in the hands and feet, but it doesn't typically present with acute swelling or the feeling of being "choked up."