Differential Diagnosis for Left Leg Pain and Swelling
- Single most likely diagnosis:
- Deep Vein Thrombosis (DVT): Given the history of a possible vein problem, recent significant swelling, and a precipitating event (feeling something pop in the calf during physical activity), DVT is a strong consideration. The swelling from the ankle up to about 3/4 of the way to the knee, without significant pain, redness, or warmth, also aligns with DVT, especially in the context of prolonged periods of immobility (12-hour shifts).
- Other Likely diagnoses:
- Muscle Strain or Calf Injury: The patient's history of feeling something pop in the calf during snowboarding/skateboarding, followed by swelling, could indicate a muscle strain or other calf injury. However, the lack of significant pain and the distribution of swelling suggest this might not be the primary issue.
- Fluid Retention: The patient mentions working 12-hour shifts, which could lead to fluid retention, especially if mobility is limited during these shifts. However, fluid retention typically would not cause such localized and significant swelling unless there's an underlying circulatory issue.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Phlegmasia Cerulea Dolens: A severe form of DVT that can lead to limb ischemia. It's less likely given the lack of severe pain and the absence of cyanosis, but it's crucial to consider due to its high morbidity and mortality.
- Compartment Syndrome: Although the patient has full range of motion and no firmness, compartment syndrome is a medical emergency that must be considered, especially with a history of trauma (feeling something pop). The absence of severe pain and other classic signs makes it less likely but not impossible.
- Rare diagnoses:
- Lymphedema: Could be considered if the swelling is chronic and not entirely explained by other causes, but it's less likely given the acute onset and the specific distribution of swelling.
- Popliteal Artery Aneurysm or Other Vascular Anomalies: These are rare but could cause swelling and pain, especially if there's a history of trauma. However, they would be less likely without other specific symptoms such as a palpable mass or significant differences in pulses between the legs.