Differential Diagnosis for Bilateral Pitting Oedema
Single Most Likely Diagnosis
- Idiopathic oedema: This condition is common in obese women and is often associated with poor venous return due to increased pressure on the veins in the legs. It can also be exacerbated by factors such as standing for long periods, hot weather, and hormonal changes.
Other Likely Diagnoses
- Venous insufficiency: Obesity can lead to increased pressure on the veins, causing them to become insufficient and leading to oedema.
- Lymphoedema: Although less common, lymphoedema can occur in obese individuals due to impaired lymphatic drainage.
- Hypothyroidism: This condition can cause oedema, particularly in the legs, and is more common in women.
- Fluid retention due to menstrual cycle: Hormonal changes during the menstrual cycle can lead to fluid retention, causing oedema in some women.
Do Not Miss Diagnoses
- Deep vein thrombosis (DVT): Although less likely, DVT is a potentially life-threatening condition that can cause unilateral or bilateral oedema and must be ruled out.
- Nephrotic syndrome: This condition can cause significant oedema due to protein loss in the urine and requires prompt diagnosis and treatment.
- Heart failure: Right-sided heart failure can cause peripheral oedema, and although less likely in a young, otherwise well woman, it is a critical diagnosis not to miss.
- Pregnancy-related complications: In a woman of childbearing age, pregnancy-related complications such as pre-eclampsia or gestational hypertension must be considered.
Rare Diagnoses
- Sarcoidosis: This condition can cause oedema due to granulomatous inflammation affecting various organs, including the lymphatic system.
- Lipedema: A rare condition characterized by abnormal fat distribution in the legs, leading to oedema and pain.
- Fabry disease: A genetic disorder that can cause oedema due to the accumulation of globotriaosylceramide in various tissues, including the skin and kidneys.