Differential Diagnosis for DM with Right Leg Swelling

Given the clinical presentation of a patient with diabetes mellitus (DM) who develops a firm, tender, partially mobile swelling that is irreducible and nonexpansile below the inguinal crease, 2 days after angiography showed diffuse disease, the differential diagnoses can be categorized as follows:

• Single Most Likely Diagnosis

  • Pseudoaneurysm: This is the most likely diagnosis given the history of recent angiography, which is a known risk factor for the development of pseudoaneurysms. The description of the swelling as firm, tender, and partially mobile, located below the inguinal crease, is consistent with a pseudoaneurysm, especially in the context of a recent vascular procedure.

• Other Likely Diagnoses

  • Femoral Hernia: Although less likely than pseudoaneurysm given the context, a femoral hernia could present as a tender, irreducible swelling below the inguinal crease. However, the association with recent angiography and the specific characteristics of the swelling make this less probable.
  • Saphena Varix: This refers to a dilated saphenous vein and could present as a swelling, but it would typically be more expansile and less likely to be tender unless thrombosed. The recent angiography does not directly increase the risk for saphena varix.

• Do Not Miss Diagnoses

  • Psoas Abscess: Although less common and not directly related to the recent angiography, a psoas abscess can present with a wide range of symptoms including swelling, pain, and can be life-threatening if not promptly diagnosed and treated. The location and description might not perfectly match, but the potential severity warrants consideration.
  • Retroperitoneal Hematoma: Not explicitly listed but could be considered in the context of recent angiography and diffuse vascular disease. It's a potentially life-threatening condition that requires immediate attention.

• Rare Diagnoses

  • Other vascular malformations or complications: There could be other rare vascular complications or malformations that could present similarly, but these would be less common and might require additional specific diagnostic testing to identify.

Each of these diagnoses has a different level of urgency and potential for morbidity, with pseudoaneurysm being the most directly related to the recent procedure and thus the most likely diagnosis given the context provided.