Differential Diagnosis for 40 YOF with Left Arm Pain and History of DVT and PE

Single Most Likely Diagnosis

• Arterial Embolism: Given the patient's history of DVT and PE, and current symptoms of arm pain, swelling, numbness, and an episode of hand discoloration (turning blue), an arterial embolism is highly plausible. The transient nature of the hand turning blue could indicate a temporary occlusion or embolic event.

Other Likely Diagnoses

• Deep Vein Thrombosis (DVT): Although the patient is on blood thinners, the possibility of a new or recurrent DVT cannot be ruled out, especially with symptoms of arm swelling and pain.
• Thrombophlebitis: Inflammation of veins due to a blood clot could cause pain and swelling, and while less likely than an arterial issue given the acute onset and nature of symptoms, it remains a consideration.
• Hematoma or Bleeding: Given the patient is on blood thinners, any trauma (even minor) could lead to significant bleeding or hematoma formation, which might cause arm pain and swelling.

Do Not Miss Diagnoses

• Aortic Dissection: Although less common, aortic dissection is a life-threatening condition that could present with acute arm pain and must be considered, especially in the context of severe, acute onset pain.
• Pulmonary Embolism (PE): While the primary complaint is arm pain, the patient's history of PE and current symptoms of numbness and transient ischemic event (hand turning blue) warrant consideration of another PE, especially if there are any respiratory symptoms.
• Septic Thrombophlebitis: An infected thrombus could cause severe inflammation and potentially life-threatening sepsis, making it crucial not to miss this diagnosis.

Rare Diagnoses

• Thoracic Outlet Syndrome (TOS): Compression of the nerves or blood vessels that pass into the thoracic outlet could cause arm pain, numbness, and swelling, but this would be less likely given the acute onset and specific symptoms of transient ischemia.
• Vasculitis: Inflammation of the blood vessels could cause a wide range of symptoms including pain, swelling, and numbness, but this would be a less common cause of the patient's specific presentation.
• Raynaud's Phenomenon: This condition causes some areas of your body — such as your fingers and toes — to feel numb and cold in response to cold temperatures or stress, but the episode of the hand turning blue for hours might not fully align with typical Raynaud's episodes, which are usually shorter.