Differential Diagnosis for 78 YOF with Swelling on Left Arm and Neck
Single Most Likely Diagnosis
- Deep Vein Thrombosis (DVT) with Pulmonary Embolism (PE) related complications or Superior Vena Cava (SVC) syndrome: The recent lung surgery is a significant risk factor for DVT and PE. The swelling on the left arm and neck could be related to these complications, especially if there's any obstruction or compression of major veins. However, the presence of crepitus suggests another possible diagnosis.
Other Likely Diagnoses
- Lymphedema: Post-surgical swelling is common, and lymphedema could be a cause, especially if there was any disruption to lymphatic vessels during surgery. However, lymphedema typically does not present with crepitus.
- Cellulitis or Soft Tissue Infection: Infection could cause swelling and crepitus due to gas production by bacteria. The recent surgery increases the risk of infection.
- Seroma or Hematoma: Fluid accumulation at the surgical site could cause swelling, but crepitus would be unusual unless there's an associated infection.
Do Not Miss Diagnoses
- Necrotizing Fasciitis: Although rare, this condition is life-threatening and can present with swelling, crepitus, and signs of infection. It requires immediate surgical intervention.
- Pulmonary Embolism with associated complications: While mentioned under the most likely diagnosis, it's crucial to consider PE in any post-surgical patient with swelling, especially if there are respiratory symptoms.
- Superior Vena Cava Syndrome due to thrombosis or other obstruction: This could cause swelling of the arm and neck and is a medical emergency.
Rare Diagnoses
- Gas Gangrene: A rare but deadly condition caused by Clostridium perfringens infection, characterized by crepitus due to gas in tissues. It's more common in wounds with poor blood supply.
- Lymphangiosarcoma (Stewart-Treves Syndrome): An extremely rare complication of chronic lymphedema, which could theoretically occur in a post-surgical setting with significant lymphatic disruption. However, this would be very unusual and not directly related to the crepitus.