Differential Diagnosis for 92 year old F with Posterior Calf Wound and Toe Blackening
- Single most likely diagnosis:
- Cellulitis with secondary ischemia or septic emboli: The patient's age, recent wound, and symptoms of swelling and blackening of toes suggest an infectious process that has led to vascular compromise or embolic events.
- Other Likely diagnoses:
- Deep Vein Thrombosis (DVT): The swelling in the foot and blackening of toes could be indicative of a DVT that has led to pulmonary embolism or has caused significant venous obstruction leading to ischemia.
- Arterial Occlusion: An acute arterial occlusion could explain the sudden onset of ischemic symptoms in the toes, especially if there's an embolic source or severe atherosclerosis.
- Diabetic Foot Infection: Although not explicitly mentioned, diabetes is a common condition in the elderly, and a foot infection could lead to similar symptoms, including blackening of toes due to gangrene.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed):
- Necrotizing Fasciitis: A severe, life-threatening infection that could arise from the calf wound, leading to rapid progression of symptoms including swelling, pain, and necrosis.
- Gas Gangrene: Caused by Clostridium perfringens, this condition can arise from wounds and leads to rapid tissue death and gas production, which is life-threatening.
- Severe Peripheral Artery Disease (PAD): While less likely to present acutely without prior symptoms, severe PAD could lead to critical limb ischemia, presenting with rest pain, ulceration, and gangrene.
- Rare diagnoses:
- Buerger's Disease (Thromboangiitis Obliterans): A rare disease of the arteries and veins in the arms and legs, which could lead to ischemia and gangrene, especially in smokers.
- Cholesterol Crystal Embolization: A rare condition where cholesterol crystals embolize and cause vascular occlusion, potentially leading to ischemic symptoms in the affected limb.
- Vasculitis: Certain types of vasculitis, such as giant cell arteritis or polyarteritis nodosa, could lead to ischemic symptoms due to inflammation of blood vessels, although these would be less common in this presentation.