Question

62 yo M has 2 day hx right arm pain. Smoker. BP 152/91. O2sats 94%, BMI 31. Pitting edema right arm & Tortuous, engorged superficial veins over right shoulder. Tip of spleen palpable below left costal margin. WBC 12500, hgb 19.5, plt 650,000. what will Dx this ?

Answer 1

The 62-year-old male patient's presentation, with right arm pain, pitting edema, engorged veins, high white blood cell count, elevated hemoglobin, and platelet count, suggests the possibility of a myeloproliferative disorder or thrombocytosis, as well as risk for thrombotic complications.

Step-by-step explanation:

The symptoms and laboratory findings of the 62-year-old male patient suggest the possibility of a thrombotic or hematologic disorder. The presence of pitting edema in the right arm, tortuous, engorged superficial veins over the right shoulder, and a palpable spleen tip, combined with an elevated white blood cell count (WBC), high hemoglobin (hgb), and elevated platelets (plt) could indicate a myeloproliferative disorder such as Polycythemia Vera or another form of thrombocytosis. However, the diagnosis would require further testing, including a complete blood count (CBC) with differential, blood smear, and possibly a bone marrow biopsy. Additionally, cardiovascular risk factors, including the patient's smoking history and hypertension, raise concerns for potential thrombotic complications. Clinical assessment should also consider differential diagnoses that could explain the localized symptoms, such as deep vein thrombosis (DVT), cellulitis, or other causes of venous congestion or obstruction.