Differential Diagnosis for Ankle Swelling in a 90y/o Patient with PAF on Eliquis
Single Most Likely Diagnosis
- Chronic Venous Insufficiency: Given the patient's age and periodic nature of ankle swelling, chronic venous insufficiency is a common condition that could lead to these symptoms. The use of Eliquis (an anticoagulant) might also hint at a predisposition to venous issues, although it's primarily used for atrial fibrillation in this context.
Other Likely Diagnoses
- Heart Failure: The patient's history of paroxysmal atrial fibrillation (PAF) and the use of Eliquis suggest cardiac involvement. Heart failure, even if not overt, could lead to fluid overload and peripheral edema.
- Nephrotic Syndrome or Renal Failure: Although less directly linked to the provided information, slightly low hemoglobin and hematocrit (H&H) could indicate chronic disease. Nephrotic syndrome or renal failure could cause edema due to hypoalbuminemia or fluid overload.
- Hypothyroidism: This condition can cause edema and is more common in the elderly. It might also contribute to slightly low H&H values due to decreased erythropoiesis.
Do Not Miss Diagnoses
- Deep Vein Thrombosis (DVT): Despite being on an anticoagulant, the risk of DVT cannot be entirely ruled out, especially in a patient with limited mobility or other risk factors. DVT is a medical emergency that requires prompt diagnosis and treatment.
- Cellulitis or Infection: Infection can cause localized swelling and redness. In an elderly patient, the presentation might be atypical, making it crucial not to miss this potentially life-threatening condition.
- Lymphedema: While less common, lymphedema could be a consideration, especially if there's a history of cancer treatment or other conditions affecting lymphatic drainage.
Rare Diagnoses
- Lipedema: A condition characterized by the abnormal growth of fat cells in the legs, leading to swelling. It's more common in women and can be mistaken for other forms of edema.
- Sarcoidosis: A systemic disease that can cause lymphadenopathy, skin lesions, and swelling in various parts of the body, including the ankles, due to granulomatous inflammation.
- Amyloidosis: A group of diseases characterized by the deposition of amyloid proteins in various tissues, which can lead to edema among other symptoms, depending on the organs involved.