Differential Diagnosis for Left Upper Extremity Swelling
- Single most likely diagnosis
- Thrombosis of the Arteriovenous (AV) Fistula: The presence of an AV fistula, recent absence from dialysis, and symptoms of swelling, pain, and a bruit sound over the fistula site make thrombosis of the AV fistula a highly likely diagnosis. The swelling and pain could be indicative of a clot formation within the fistula, which is a common complication, especially if the patient has missed dialysis sessions.
- Other Likely diagnoses
- Cellulitis: The erythema, warmth, and direct tenderness to touch on the mid forearm area suggest an infectious process such as cellulitis. This could be related to the AV fistula or a separate issue.
- Venous Stenosis or Thrombosis: Given the history of dialysis and the presence of an AV fistula, venous stenosis or thrombosis is a possible cause of the swelling. This condition can lead to inadequate dialysis and swelling of the affected limb.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Sepsis: Although the patient does not have fever, the presence of erythema, warmth, and tenderness could indicate a localized infection. Sepsis is a life-threatening condition that requires immediate attention, especially in patients with compromised health status like those on dialysis.
- Ischemia of the Left Upper Extremity: Reduced blood flow due to thrombosis or stenosis of the AV fistula or its feeding arteries could lead to ischemia, which is a medical emergency.
- Rare diagnoses
- Vasculitis: An inflammatory condition affecting the blood vessels, which could potentially cause swelling and pain in the upper extremity. However, this would be less common and might require additional symptoms or laboratory findings to support the diagnosis.
- Neoplasm: A tumor could cause swelling and pain, but this would be an uncommon cause of acute swelling in the context of an AV fistula and recent dialysis absence.