Differential Diagnosis for Bilateral Lower Extremity Edema with Erythema and Tenderness
- Single Most Likely Diagnosis
- Deep Vein Thrombosis (DVT): The combination of 3+ pitting edema, erythema, and tenderness in one leg, along with the inability to keep still in the evenings (possibly indicating restlessness or pain), strongly suggests DVT. The presence of a bump could be indicative of a thrombosed vein.
- Other Likely Diagnoses
- Cellulitis: The erythema and tenderness, especially if the skin is warm to the touch, could indicate a bacterial infection of the skin and subcutaneous tissue, which is cellulitis. The bump could be an abscess or a localized area of infection.
- Chronic Venous Insufficiency: This condition could explain the bilateral edema and could be exacerbated by factors such as prolonged standing, obesity, or previous DVT, leading to increased venous pressure and fluid leakage into the tissues.
- Lymphedema: Although less likely given the acute presentation, lymphedema could cause significant edema, especially if there's a history of lymph node removal or radiation therapy. However, lymphedema typically does not present with erythema or a bump.
- Do Not Miss Diagnoses
- Pulmonary Embolism (PE): Although PE itself does not directly cause leg edema or erythema, it is a potentially life-threatening complication of DVT. Any suspicion of DVT should prompt consideration of PE, especially if there are respiratory symptoms.
- Necrotizing Fasciitis: This is a severe infection of the fascia and tissues beneath the skin, which can present with erythema, swelling, and pain out of proportion to the appearance of the skin. It is a medical emergency.
- Compartment Syndrome: This condition, characterized by increased pressure within a muscle compartment, can cause pain, swelling, and tenderness. It is a medical emergency that requires prompt intervention to prevent permanent damage.
- Rare Diagnoses
- Erythema Nodosum: A type of skin inflammation that presents with tender red nodules, typically on the shins. It can be associated with various conditions, including infections, autoimmune diseases, and medications.
- Lipedema: A chronic condition characterized by the abnormal growth of fat cells in the legs, leading to swelling and tenderness. It does not typically present with erythema or a sudden onset.
- Filariasis: In endemic areas, filariasis can cause significant lymphedema and elephantiasis. However, the presentation would typically be more chronic, and the bump might represent a lymphatic nodule or hydrocele in males.