Your Differential please...

[marchiafava]

A 40 y/o woman with no sig PMH presents to her PC Doc with Left hand swelling which is associated with some mild discomfort off and on for the last couple months. Recently the swelling became much worse. She denies any parasthesias, muscle weakness, or joint pains.

No sig PSH, FH, ALL
Meds- none

can't give labs because this is a patient my buddy briefly presented to me. What is in your diff for unilateral hand swelling without severe pain or neurological deficit. Thanks

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[docB]

DVT until proven otherwise.

 

[monkeyarms]

agree w/ dvt...also metastasis->lymphatic obstruction?

 

[Idiopathic]

agree w/ dvt...also metastasis->lymphatic obstruction?

DVT in the hand/arm??

 

[southerndoc]

DVT in the hand/arm??

Yes, it can occur in the arm, or more likely in the subclavian.

Any history of instrumentation of her SC?

I agree with the diff of lymphatic involvement (tumor, metastasis, infection, etc.).

What is her breast exam like? I'm assuming her left arm is without discoloration/temperature (or other signs of cellulitis). I'm also assuming the patient's arm swelling isn't just limited to a joint... i.e., it's her entire arm or forearm and not just her elbow or wrist.

 

[Sessamoid]

DVT in the hand/arm??

Just saw one today as a matter of fact. Had DVT in right int jug too. Not common, but certainly not unheard of in certain patient populations.

After DVT:

Cellulitis
Reflex sympathetic dystrophy
contact dermatitis
Occasionally punching a brick wall....

 

[NinerNiner999]

Also possibilities:

GC
Erysipelas
Lymphatic obstruction