Edema vs Clot

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The following activity includes several case presentations of edema. Make a diagnosis for each case, remembering the following questions: 

  1. Is the edema acute/sudden or chronic (e.g., duration, progression)?
  2. Is it unilateral or bilateral? Is the edema generalized or localized?
  3. Is it pitting or nonpitting?
  4. Is it dependent?
  5. In addition to edema, what other characteristics are associated with the edema (e.g., redness, pain)?
  6. What is the pertinent past or coexisting medical history? What medications is the patient taking?

You may want to refer to chapter 3 and chapter 4 to help determine the diagnosis. 

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. 

  •  
    • 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

  1. Identify the probable diagnosis and what data support your decision.
  2. Describe the pathogenesis for the diagnosis.
  3. What data are inconsistent with your diagnosis?
  4. What diagnostic tests would you order, if any, and how would you treat this patient

40-year-old Mr. Jason is complaining of right leg swelling, pain, erythema, and warmth for the past 2 days. The swelling started after he accidentally cut the front of his leg with a pocketknife while fishing. 

  • Past medical history: hypertension.
  • Medications: amlodipine.
  • Social history: drinks four to five beers on the weekends and has smoked one or two cigarettes a day for the last 15 years (he states he is trying to quit).
  • Physical examination: temperature 100°F; pulse 88 beats per minute; respirations 18 per minute; blood pressure 140/92 mmHg; examination unremarkable except for edematous anterior right leg with open linear wound approximately 1-inch long; wound with scant purulent drainage; and area is warm and tender with blanching erythema that extends 3 inches around the wound.
  • Note: Assume history and examination is within normal limits if not listed.

Activity

  1. Identify the probable diagnosis and what data support your decision.
  2. Describe the pathogenesis for the diagnosis.
  3. What data are inconsistent with your diagnosis?
  4. What diagnostic tests would you order, if any, and how would you treat this patient?