Differential Diagnosis for Left Leg Swelling and Mass

The symptoms described, including a swollen left leg with a palpable mass, tenderness, and heaviness, suggest a range of possible conditions. Here's a categorized differential diagnosis:

• Single Most Likely Diagnosis

  • Chronic Venous Insufficiency (CVI): This condition is characterized by the veins having problems returning blood from the legs back to the heart due to issues like faulty valves. It can lead to swelling, pain, and a feeling of heaviness in the legs. The description of the leg feeling "swallowed" and the presence of a mass could be indicative of edema and possibly a venous ulcer or varicose veins, which are common in CVI.

• Other Likely Diagnoses

  • Lymphedema: A condition where the lymph nodes or lymphatic vessels are damaged or blocked, leading to a buildup of lymph fluid, causing swelling in the affected limb. The feeling of a "mass of meat or water" could be consistent with lymphedema.
  • Deep Vein Thrombosis (DVT): Although DVT typically presents with acute symptoms, chronic or recurrent DVT could lead to chronic swelling and tenderness. The mass felt could potentially be a thrombosed vein.
  • Varicose Veins: These are enlarged, twisted veins that can cause swelling, pain, and a feeling of heaviness, especially if they become thrombosed.

• Do Not Miss Diagnoses

  • Malignancy (e.g., Soft Tissue Sarcoma): Although rare, a soft tissue sarcoma could present as a mass. Given the duration of symptoms, it's crucial to rule out malignancy.
  • Infection or Abscess: A chronic infection or abscess could cause swelling, tenderness, and a palpable mass. This would be particularly concerning if there's a history of trauma, recent travel, or immune compromise.
  • Nerve Compression or Neuroma: While less likely to cause swelling, nerve compression or a neuroma could lead to pain and a sensation of heaviness, and in some cases, could be associated with a palpable mass.

• Rare Diagnoses

  • Lipedema: A chronic condition characterized by the abnormal growth of fat cells in the legs, leading to swelling and pain. It's more common in women and can be mistaken for obesity or lymphedema.
  • Filarial Elephantiasis: In endemic areas, this parasitic infection can cause severe swelling and lymphedema. Given the description, it's less likely but should be considered based on travel history.

It's essential to consult a healthcare professional for a thorough evaluation, including physical examination, imaging studies (like ultrasound or MRI), and possibly a biopsy if malignancy is suspected. The chronic nature of the symptoms necessitates a comprehensive approach to diagnose and manage the condition effectively.