Given these changes from the original case, what is your diagnosis?
What is your diagnostic explanation?
As compared to the long case, this patient is a 65 year old female who presents to the clinic with bilateral swelling of the legs. She reports the swelling has been gradual and progressive over the past few months. She also notes that the veins of her legs appear larger and look as if they may “pop” at any moment. She denies any erythema or pain associated with the swelling. The patient is unhappy with the appearance of her legs and says she can no longer wear shorts due to the swelling and the sight of her veins. She reports she has been gaining weight over the past few years and is currently unhappy with her weight. She reports sitting and watching television more over the past year since her retirement. She also reports that she hasn’t exercised in the past few years.
Past Medical History –
Illnesses: HTN, HLD, Hypothyroidism
Medications: Lisinopril 10mg qd, Simvastatin 40mg qd, Levothyroxine 0.125mg qd
Surgeries: Hysterectomy at age 50, Cholecystectomy at age 45
Hospitalizations: none, except for surgeries mentioned above and childbirth
Family Medical History: Mother, died at age 82 of breast cancer; Father, died at age 75 of lung cancer; Son, age 45, diagnosed with HTN and HLD; Daughter, age 42, diagnosed with HTN
Social History: Noncontributory
Review of Systems: Noncontributory
Physical Exam –
General: Female patient with appearance consistent with stated age. Patient is in no distress.
Vital Signs: BP:130/85, P:75, RR:18, BMI:34, T:99
Neck: Non-tender to palpation. No thyromegaly or lymphadenopathy present. No JVD.
Respiratory: Normal respirations, no accessory muscle use. Vesicular breath sounds present bilaterally. No wheezes, rales, or rhonchi present.
Cardiovascular: Regular rate and rhythm. S1 and S2 of normal intensity. No murmurs, rubs, or gallops.
Musculoskeletal/Extremities: Dilated, tortuous superficial veins present bilaterally. 2+ pitting edema present bilaterally in the lower extremities extending to the knees. Full ROM of extremities. No weakness noted in upper or lower extremities.
Laboratories –
TSH: normal
BMP: normal BUN and creatinine