DVT
The following activity includes several case presentations of edema. Make a diagnosis for each case, remembering the following questions:
- Is the edema acute/sudden or chronic (e.g., duration, progression)?
- Is it unilateral or bilateral? Is the edema generalized or localized?
- Is it pitting or nonpitting?
- Is it dependent?
- In addition to edema, what other characteristics are associated with the edema (e.g., redness, pain)?
- What is the pertinent past or coexisting medical history? What medications is the patient taking
68-year-old Mr. Quincy is complaining of left leg swelling for the past 2 weeks. The swelling started while he was on a cruise. The swelling is intermittent and below the knee to his foot. He describes a cramplike pain in his left calf. Lately, both legs have been cramping while walking, but it resolves when he sits. He denies any fever, warmth, erythema, or trauma.
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- Past medical history: iliofemoral deep vein thrombosis of his left leg after he had left hip replacement for osteoarthritis 9 months ago; treated with rivaroxaban for 6 months; stable angina; obesity (BMI 31); dyslipidemia.
- Social history: quit smoking 4 years ago but resumed one-fourth pack per day 1 year ago.
- Medications: simvastatin; aspirin; metoprolol.
- Note: Assume history and examination is within normal limits if not listed.
Physical examination: vital signs are within normal limits; right leg is within normal limits except hairless, shiny skin; left leg has 1+ pitting edema in the pretibial area and foot; mild pain with left calf compression and one small tortuous vein on the medial aspect of his calf; left leg is also hairless and shiny. A venous duplex Doppler ultrasound of his left leg was done and reveals no deep vein thrombosis.
Activity
- Identify the probable diagnosis and what data support your decision.
- Describe the pathogenesis for the diagnosis.
- What data are inconsistent with your diagnosis?
- What diagnostic tests would you order, if any, and how would you treat this patient?
