An 85-year-old woman who underwent colon cancer surgery 2 months ago is brought to
the clinic by her daughter because she has been complaining of painful swelling of her
left leg. The patient says she has been feeling otherwise well except for a 2-week history
of pain, swelling, and redness in her upper left calf. She denies any history of similar
problems in the past and denies acute or repetitive trauma to the area; she says that,
in fact, she has been avoiding exercise or walking unnecessarily since her surgery. She
denies any other medical or surgical history and takes atenolol and aspirin daily. Vital
signs include a temperature of 37.0°C (98.6°F), blood pressure of 135/90 mm Hg, pulse
rate of 60/min, and respiratory rate of 12/min. Her physical examination demonstrates
no jugular venous distention; clear lung fi elds; a regular heart rate and rhythm without
murmurs, rubs, or gallops; and a normal abdomen. Her left calf has pitting edema and
is approximately 4 cm larger in circumference than the right calf. It is erythematous
on the posterior aspect and tender to palpation. Neurologic and skin examinations are
otherwise unremarkable.
Right Answer IS :
the clinic by her daughter because she has been complaining of painful swelling of her
left leg. The patient says she has been feeling otherwise well except for a 2-week history
of pain, swelling, and redness in her upper left calf. She denies any history of similar
problems in the past and denies acute or repetitive trauma to the area; she says that,
in fact, she has been avoiding exercise or walking unnecessarily since her surgery. She
denies any other medical or surgical history and takes atenolol and aspirin daily. Vital
signs include a temperature of 37.0°C (98.6°F), blood pressure of 135/90 mm Hg, pulse
rate of 60/min, and respiratory rate of 12/min. Her physical examination demonstrates
no jugular venous distention; clear lung fi elds; a regular heart rate and rhythm without
murmurs, rubs, or gallops; and a normal abdomen. Her left calf has pitting edema and
is approximately 4 cm larger in circumference than the right calf. It is erythematous
on the posterior aspect and tender to palpation. Neurologic and skin examinations are
otherwise unremarkable.
Right Answer IS :
The differential diagnosis of pain and swelling in a lower extremity
includes cellulitis, deep venous thrombosis, knee injury, lymphangitis
or lymph obstruction, muscle strain or tear, popliteal (Baker’s) cyst,
superfi cial thrombophlebitis, and venous insuffi ciency.
Most Probable Diagnosis: DVT
includes cellulitis, deep venous thrombosis, knee injury, lymphangitis
or lymph obstruction, muscle strain or tear, popliteal (Baker’s) cyst,
superfi cial thrombophlebitis, and venous insuffi ciency.
Most Probable Diagnosis: DVT
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