Differential Diagnosis for a 30-year-old Male with Lumbar Contusion and Swelling of the Left Upper Leg after a Fall
- Single most likely diagnosis:
- Muscle contusion or hematoma: This is the most likely diagnosis given the history of a fall and the presence of a lumbar contusion. The swelling in the left upper leg could be due to a direct blow to the muscle, leading to bleeding into the muscle tissue.
- Other Likely diagnoses:
- Deep vein thrombosis (DVT): Although less common in young individuals, DVT can occur, especially after trauma. The swelling in the leg could be a sign of a blood clot.
- Soft tissue injury (e.g., strain or sprain): The fall could have caused an injury to the soft tissues around the knee or hip, leading to swelling.
- Compartment syndrome: This condition, characterized by increased pressure within a muscle compartment, can occur after trauma and cause swelling, pain, and decreased mobility.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed):
- Popliteal artery injury: A severe injury to the popliteal artery could lead to significant bleeding, ischemia, or even limb loss if not promptly addressed.
- Femoral fracture: A fracture of the femur could cause significant bleeding, swelling, and instability, requiring immediate medical attention.
- Pelvic fracture with associated vascular injury: A pelvic fracture could be associated with significant internal bleeding or vascular injury, which would be life-threatening if not promptly diagnosed and treated.
- Rare diagnoses:
- Rhabdomyolysis: Although rare, severe muscle injury from the fall could lead to rhabdomyolysis, a condition where muscle tissue breaks down, releasing myoglobin into the bloodstream and potentially causing kidney damage.
- Neurogenic shock: If the lumbar contusion is severe enough to cause spinal cord injury, it could lead to neurogenic shock, characterized by hypotension, bradycardia, and peripheral vasodilation.