Differential Diagnosis for Left Face Bruising in a 69-Year-Old Female
Single Most Likely Diagnosis
- Trauma: The most common cause of facial bruising in any age group is trauma, which could be due to a fall, assault, or accidental injury. Given the age of the patient, even a minor trauma could result in significant bruising due to decreased skin elasticity and increased fragility of blood vessels.
Other Likely Diagnoses
- Hypertension: Uncontrolled hypertension can lead to blood vessel fragility, making them more susceptible to rupture and bruising, even without significant trauma.
- Medication Side Effects: Certain medications, such as anticoagulants (e.g., warfarin, aspirin), can increase the risk of bruising by affecting blood clotting.
- Skin Conditions: Conditions like eczema, dermatitis, or skin infections could potentially lead to facial bruising, although this would typically be accompanied by other skin symptoms.
- Vitamin Deficiencies: Deficiencies in vitamins like C or K can affect collagen synthesis and blood clotting, respectively, potentially leading to increased bruising.
Do Not Miss Diagnoses
- Basilar Skull Fracture: Although less common, a basilar skull fracture could present with facial bruising (raccoon eyes or Battle's sign) and is a medical emergency.
- Temporal Arteritis: This condition, more common in older adults, involves inflammation of the blood vessels and can present with facial pain, headache, and potentially bruising, although the latter is less typical.
- Endocarditis: Infective endocarditis can cause embolic phenomena, including Janeway lesions (small, hemorrhagic lesions on the palms and soles), but facial bruising could be a part of the presentation in rare cases.
Rare Diagnoses
- Amyloidosis: This condition involves the deposition of abnormal proteins (amyloid) in various tissues, including blood vessels, which can lead to increased fragility and bruising.
- Vasculitis: Certain types of vasculitis, such as granulomatosis with polyangiitis (formerly known as Wegener's granulomatosis), can present with a wide range of symptoms including skin bruising, although this is uncommon.
- Bleeding Disorders: Conditions like hemophilia or von Willebrand disease are rare and typically present earlier in life but could be considered in the differential diagnosis of unexplained bruising, especially if there's a relevant family history.