Differential Diagnosis for Bilateral Leg Swelling in a 50-year-old Female with Hypertension
- Single most likely diagnosis:
- Chronic Venous Insufficiency: This condition is common in adults, especially those with a history of hypertension, and can lead to bilateral leg swelling due to the inability of veins to return blood to the heart efficiently.
- Other Likely diagnoses:
- Heart Failure: Hypertension is a significant risk factor for heart failure, which can cause fluid buildup in the legs, leading to swelling.
- Nephrotic Syndrome: This kidney disorder can cause significant protein loss in the urine, leading to low albumin levels, which in turn can cause fluid to leak out of blood vessels and into the tissues, resulting in swelling.
- Liver Cirrhosis: Cirrhosis can lead to fluid retention and swelling in the legs due to portal hypertension and hypoalbuminemia.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Deep Vein Thrombosis (DVT): Although less common than other causes, DVT is a potentially life-threatening condition that requires immediate attention. It can cause unilateral or bilateral leg swelling.
- Lymphoma or Other Malignancies: Certain cancers can cause lymphatic obstruction, leading to swelling. Early detection is crucial for effective treatment.
- Pulmonary Embolism: While it primarily presents with respiratory symptoms, a large pulmonary embolism can lead to acute right heart failure, causing bilateral leg swelling.
- Rare diagnoses:
- Lipedema: A chronic condition characterized by the abnormal growth of fat cells in the legs, leading to swelling and pain.
- Sarcoidosis: An autoimmune disease that can affect multiple organs, including the lymph nodes, and cause swelling in the legs.
- Fabry Disease: A rare genetic disorder that can lead to the accumulation of a particular type of fat in the body's cells, affecting many parts of the body and potentially causing leg swelling.