Differential Diagnosis

The patient's presentation is complex, involving gastrointestinal, cardiovascular, and psychological symptoms. The following differential diagnoses are considered:

• Single most likely diagnosis
  • Congestive heart failure: The patient's symptoms of shortness of breath, lethargy, decreased exercise tolerance, and marked bilateral leg edema are suggestive of congestive heart failure. The absence of organomegaly or abdominal masses and the presence of shifting dullness also support this diagnosis.
• Other Likely diagnoses
  • Liver disease (e.g., cirrhosis): The patient's abdominal discomfort, polyuria, and hematuria, as well as the presence of prominent abdominal veins and striae, could indicate liver disease. However, the absence of jaundice and other stigmata of chronic liver disease makes this less likely.
  • Renal vein thrombosis: Although nephrotic syndrome was initially considered and excluded, renal vein thrombosis could still be a possibility, especially given the patient's history of hematuria and abdominal discomfort.
  • Constrictive pericarditis: The patient's symptoms of shortness of breath, lethargy, and decreased exercise tolerance, as well as the presence of prominent abdominal veins and striae, could also be indicative of constrictive pericarditis.
• Do Not Miss
  • Pulmonary embolism: Although the patient's symptoms are more suggestive of congestive heart failure, pulmonary embolism is a potentially life-threatening condition that must be considered, especially given the patient's shortness of breath and decreased exercise tolerance.
  • Cardiac tamponade: The patient's symptoms of shortness of breath, lethargy, and decreased exercise tolerance, as well as the presence of prominent abdominal veins and striae, could also be indicative of cardiac tamponade.
• Rare diagnoses
  • Superior vena cava syndrome: The patient's symptoms of shortness of breath, lethargy, and decreased exercise tolerance, as well as the presence of prominent abdominal veins and striae, could be indicative of superior vena cava syndrome, although this is a rare condition.
  • Budd-Chiari syndrome: The patient's history of abdominal discomfort, polyuria, and hematuria, as well as the presence of prominent abdominal veins and striae, could be indicative of Budd-Chiari syndrome, although this is a rare condition.