A 40-year-old farmer presents to his primary care physician with complaints of dull pain and swelling in his left leg. He notes that the swelling decreases when he elevates his limb. On physical examination, the swelling is found to pit on pressure, and there is a positive Stemmer’s sign (inability to pinch the skin on the dorsal surface of the toes due to thickening).
What is the most likely diagnosis?
A. DVT
B. Lymphedema
C. Nephrotic syndrome
D. Varicose veins
Answer:
The Correct Answer is: B. Lymphedema
Explanation:
Lymphedema (B):
– Lymphedema is characterized by swelling due to the accumulation of lymphatic fluid in the tissues. It often presents with dull pain and swelling that can reduce with limb elevation.
– The swelling is typically pitting in the early stages but can become non-pitting in later stages.
– A positive Stemmer’s sign is a classic indicator of lymphedema. This sign is positive when the skin on the dorsal aspect of the toes or fingers cannot be pinched due to thickening, which is a specific finding in lymphedema.
Explanation of Incorrect Options:
DVT (A):
– Deep Vein Thrombosis (DVT) often presents with sudden onset of pain, swelling, and redness in the affected limb. It is usually not associated with a positive Stemmer’s sign.
– DVT is a serious condition and typically requires prompt medical intervention to prevent complications like pulmonary embolism.
Nephrotic syndrome (C):
– Nephrotic syndrome can cause generalized edema, including swelling of the limbs. However, it is typically associated with proteinuria, hypoalbuminemia, and other systemic signs.
– The swelling in nephrotic syndrome is usually more generalized and not specific to one limb, and a positive Stemmer’s sign is not a characteristic feature.
Varicose veins (D):
– Varicose veins are dilated, tortuous veins usually found in the lower limbs. They can cause aching, heaviness, and swelling, particularly after prolonged standing.
– While they can cause limb swelling, they are not typically associated with pitting edema or a positive Stemmer’s sign.
In conclusion, the most likely diagnosis for a patient with dull pain, pitting edema, and a positive Stemmer’s sign in the limb is lymphedema, making option B the correct answer.