Differential Diagnosis for 78 YOF with Swelling on Left Arm and Neck
Single Most Likely Diagnosis
- Lymphedema or Seroma with Subcutaneous Emphysema: Given the recent lung surgery, the swelling on the left arm and neck could be due to disruption of lymphatic vessels or accumulation of fluid (seroma) at the surgical site, complicated by subcutaneous emphysema (air in the tissues) which would explain the crepitus. This is a common complication post-surgery, especially after procedures that involve areas with rich lymphatic drainage.
Other Likely Diagnoses
- Deep Vein Thrombosis (DVT): Postoperative patients are at increased risk for DVT, which can cause swelling in the affected limb. However, DVT typically does not cause crepitus.
- Cellulitis: An infection of the skin and subcutaneous tissues, which could be a complication of the surgery. While cellulitis can cause swelling and redness, crepitus is not a typical finding unless there is also gas in the tissues due to a gas-producing organism.
- Pulmonary Embolism with Secondary Effects: Although not directly causing arm swelling, a pulmonary embolism could lead to decreased mobility and increased risk of other conditions like DVT. The swelling in this case might be coincidental or related to another factor.
Do Not Miss Diagnoses
- Necrotizing Fasciitis: A severe infection of the fascia, which could be life-threatening. It can cause swelling, pain, and crepitus due to gas production by the infecting organisms. Although less likely, missing this diagnosis could be fatal.
- Superior Vena Cava Syndrome: Obstruction of the superior vena cava, which could be due to a thrombus or external compression from a tumor or hematoma, especially in the context of recent surgery. This condition can cause swelling of the face, neck, and arms, and is a medical emergency.
Rare Diagnoses
- Lymphangiosarcoma (Stewart-Treves Syndrome): A rare malignant tumor that arises in the context of chronic lymphedema. Given the acute presentation post-surgery, this is highly unlikely but mentioned for completeness.
- Air Embolism: Although more commonly associated with immediate postoperative complications, an air embolism could theoretically cause subcutaneous emphysema and other systemic symptoms. However, this would typically present with more dramatic and immediate symptoms rather than localized swelling and crepitus.