Differential Diagnosis for Swollen and Erythematous Area after Peripheral Line Removal

• Single most likely diagnosis:

  • Phlebitis: This is the most likely diagnosis given the history of a peripheral line in the antecubital area. Phlebitis, or inflammation of the vein, can occur due to the presence of a foreign body (the IV line) and can lead to swelling and erythema (redness) in the affected area. The fact that symptoms have appeared after the line was removed is consistent with this diagnosis, as the body may react to the removal of the irritant by increasing inflammation.

• Other Likely diagnoses:

  • Cellulitis: This is an infection of the skin and subcutaneous tissues that can occur at the site of an IV line, especially if the line was not properly cared for or if the skin was broken during insertion or removal. The symptoms of cellulitis, including redness, swelling, and warmth, are similar to those described.
  • Thrombophlebitis: This condition involves both a blood clot (thrombus) and inflammation of the vein. It can occur in the setting of an IV line and might present with swelling, erythema, and a palpable cord, which is consistent with the description provided.

• Do Not Miss (ddxs that may not be likely, but would be deadly if missed):

  • Sepsis: Although less likely, if the IV site became infected and bacteria entered the bloodstream, the patient could develop sepsis, a potentially life-threatening condition. Early recognition and treatment of sepsis are crucial.
  • Necrotizing Fasciitis: This is a rare but serious infection of the tissue beneath the skin and surrounding muscles and organs. It can occur after a skin injury, including the insertion site of an IV line. The infection can spread rapidly and is life-threatening, making prompt diagnosis and treatment essential.

• Rare diagnoses:

  • Pyogenic Granuloma: This is a rare, benign vascular tumor that can appear as a red, bleeding bump on the skin, often at sites of trauma or injury, including IV insertion sites. While not typically presenting as a swollen, erythematous cord, it could be considered in the differential diagnosis for unusual reactions at IV sites.
  • Erythema Induratum: A form of panniculitis (inflammation of the subcutaneous fat) that can present with tender, erythematous nodules, typically on the lower legs but potentially elsewhere, including the site of an IV line. It is a rare condition and less likely but could be considered in the differential diagnosis for unexplained erythema and swelling.