A swollen leg
- By: Rebecca Dicks, Stephen Sandys, CJL Hetherington
This 81 year old man presented to the emergency department with a 24 hour history of increasing pain and swelling of his left leg. His medical history includes atrial fibrillation and advanced prostate cancer, for which he is being treated with diethylstilbestrol, an oestrogen hormone. On examination his left leg had a mottled dusky blue appearance and was markedly swollen, with the left and right calf circumferences measuring 43 cm and 38 cm respectively. On palpation the leg was cool to touch, tender, and blanched to pressure. Examination with a handheld Doppler ultrasound indicated good arterial flow in the posterior tibial artery bilaterally.
(1) What is the likely diagnosis in this man, and what differentials would you consider?
(2) What are the risk factors for this condition?
(3) How would you confirm the diagnosis?
(4) How would you treat this man?
(1) This man has a large deep vein thrombosis