Differential Diagnosis for Unilateral Pitting Pedal Edema in a 60-Year-Old Man
- Single Most Likely Diagnosis
- Chronic Venous Insufficiency: This condition is a common cause of unilateral pitting edema, especially in older adults. It occurs due to the incompetence of venous valves, leading to blood pooling in the affected limb.
- Other Likely Diagnoses
- Deep Vein Thrombosis (DVT): Although DVT typically presents with acute onset of swelling, it can sometimes cause chronic or subacute swelling if not fully occlusive or if there's a partial recanalization.
- Lymphedema: This can be primary (rare) or secondary due to surgery, infection, or malignancy. It's less likely to be pitting in nature but should be considered, especially if the edema is chronic.
- Cellulitis or Infection: Infections of the skin and soft tissues can cause edema, which may be pitting, especially in the acute phase.
- Do Not Miss Diagnoses
- Malignancy (e.g., lymphoma, metastatic disease): Although rare, malignancies can cause unilateral edema by obstructing lymphatic or venous return. Missing this diagnosis could have severe consequences.
- Pulmonary Embolism with DVT: While the primary concern with pulmonary embolism is respiratory, it often originates from a DVT, which can cause leg swelling.
- Abdominal or Pelvic Mass: A mass compressing the iliac veins or lymph nodes can lead to unilateral edema. This could be due to various causes, including malignancy or large benign tumors.
- Rare Diagnoses
- Filariasis: In endemic areas, filariasis can cause lymphedema, which might present as unilateral pitting edema, although it's typically non-pitting.
- Arteriovenous Fistula: An abnormal connection between arteries and veins can lead to increased venous pressure and edema.
- Fabry Disease: A genetic disorder that can lead to vascular dysfunction and edema, among other symptoms.
- Sarcoidosis: A systemic disease that can affect lymph nodes and cause lymphedema, although this is a rare manifestation.