Differential Diagnosis for 94-year-old with Swollen Ankles, SOB, and Frequent Urination
Single Most Likely Diagnosis
- Congestive Heart Failure (CHF): This condition is highly likely given the combination of symptoms such as swollen ankles (edema), shortness of breath (SOB), and frequent urination. CHF leads to fluid buildup in the body, causing edema and increased urine production as the body tries to compensate.
Other Likely Diagnoses
- Chronic Kidney Disease (CKD): CKD can cause fluid retention leading to edema and shortness of breath. It also affects the kidneys' ability to concentrate urine, leading to frequent urination.
- Nephrotic Syndrome: Characterized by significant proteinuria, hypoalbuminemia, and edema. While less common, it could explain the edema and potentially contribute to shortness of breath if there's associated fluid overload.
- Diuretic Resistance or Non-adherence in a Patient with Known Heart Failure: If the patient is already on diuretics for heart failure, resistance or non-adherence could lead to worsening symptoms.
Do Not Miss Diagnoses
- Pulmonary Embolism (PE): Although less likely, PE is a life-threatening condition that can cause sudden onset of shortness of breath and could be associated with leg swelling if there's a deep vein thrombosis (DVT) present. It's crucial not to miss this diagnosis.
- Acute Kidney Injury (AKI): Sudden decline in kidney function can lead to fluid overload (causing edema and SOB) and changes in urination frequency. Identifying and treating the cause of AKI is critical.
- Cardiac Tamponade: A life-threatening condition where fluid accumulates in the sac around the heart, impeding its ability to pump. It can cause shortness of breath and potentially edema if there's associated heart failure.
Rare Diagnoses
- Lymphedema: A condition characterized by chronic swelling, typically in one limb, due to lymphatic system dysfunction. It's less likely to cause shortness of breath or frequent urination but could be considered if other symptoms are present.
- Constrictive Pericarditis: A rare condition where the pericardium (the sac surrounding the heart) becomes stiff and fibrotic, restricting heart function. It can cause edema, shortness of breath, and potentially changes in urination patterns due to decreased cardiac output.
- Superior Vena Cava Syndrome: Obstruction of the superior vena cava can cause edema and shortness of breath, but it's a rare condition, often associated with malignancies or thrombosis.