Differential Diagnosis

• Single most likely diagnosis
  • Arteriovenous Fistula (AVF): The patient's history of arterial bleeding from a puncture wound, followed by the formation of a large hematoma after a minor trauma, suggests the possibility of an AVF. The initial bleeding and subsequent swelling, despite resolution of the initial bleeding, could indicate an abnormal connection between an artery and a vein.
• Other Likely diagnoses
  • Pseudoaneurysm: Given the patient's history of arterial bleeding and the development of a hematoma after minor trauma, a pseudoaneurysm is a plausible diagnosis. This condition occurs when there is a leakage of arterial blood from an injured artery into the surrounding tissue, forming a sac-like structure.
  • Hematoma with ongoing bleeding: The patient's symptoms of swelling and hematoma formation, especially after minor trauma, could indicate ongoing bleeding into the hematoma. This could be due to various factors, including incomplete resolution of the initial injury or the development of a bleeding disorder.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Compartment Syndrome: Although the patient denies significant pain and distal symptoms, compartment syndrome is a critical condition that requires prompt recognition and treatment. It can occur after trauma, especially with significant swelling or hematoma formation, and can lead to severe consequences if not addressed promptly.
  • Infection (e.g., abscess or cellulitis): Infection is a potential complication of any traumatic injury, especially if the wound was not properly cleaned or if there was a delay in seeking medical attention. While the patient's current symptoms do not strongly suggest infection, it is essential to consider this possibility, especially if the patient's condition worsens or if there are signs of systemic illness.
• Rare diagnoses
  • Vascular malformation: A vascular malformation, such as a venous or arteriovenous malformation, could potentially cause the patient's symptoms, especially if the malformation was injured during the initial trauma. However, this diagnosis is less likely given the patient's age and the absence of any prior symptoms.
  • Bleeding disorder: A bleeding disorder, such as hemophilia or a platelet disorder, could contribute to the patient's ongoing bleeding and hematoma formation. However, this diagnosis is unlikely given the patient's age and the absence of any prior bleeding episodes.