Differential Diagnosis
- Single most likely diagnosis
- Peripheral Arterial Occlusion (PAO) due to Peripheral Arterial Disease (PAD): The patient's history of previous amputations due to PAOD, current symptoms of blackening and pain in the fingers, and high blood pressure suggest a high likelihood of PAO. The gradual involvement of multiple digits also points towards a vascular cause.
- Other Likely diagnoses
- Embolic event: Given the patient's history of vascular disease, an embolic event causing occlusion of the digital arteries is possible. The sudden onset of symptoms supports this diagnosis.
- Vasculitis: Although less likely, vasculitis could cause similar symptoms, especially if the patient has an underlying autoimmune condition. However, the patient's age and history of vascular disease make this less probable.
- Raynaud's phenomenon: This condition could cause digital ischemia and pain, but it typically affects multiple digits simultaneously and is often triggered by cold or stress.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Aortic dissection: Although the patient does not have chest pain, aortic dissection can sometimes present with limb ischemia without typical chest pain. Missing this diagnosis could be fatal.
- Septic emboli: If the patient has an underlying infection, septic emboli could cause digital ischemia and would require prompt antibiotic treatment.
- Rare diagnoses
- Buerger's disease (Thromboangiitis obliterans): This rare condition causes inflammation and thrombosis of blood vessels, leading to ischemia. However, it typically affects younger patients and is often associated with smoking.
- Cryoglobulinemia: This condition can cause vasculitis and digital ischemia, but it is rare and would require specific laboratory tests for diagnosis.
- Cholesterol crystal embolization: This condition can cause digital ischemia, but it is rare and often associated with recent vascular procedures or anticoagulation.