Case history
Case history
A 65-year-old woman presents with unilateral leg pain and swelling of 5 days' duration. She has a history of hypertension, congestive heart failure, and recent hospitalisation for a total knee replacement. She had been recuperating at home but on beginning to walk, her right leg became painful, tender, and swollen. On examination there is pitting oedema on the right and the right calf is 4 cm greater in circumference than the left when measured 10 cm below the tibial tuberosity. Superficial veins on the right foot are more dilated than on the left and easily visible. The right leg is slightly redder than the left. There is tenderness on palpation in the popliteal fossa behind the right knee.
Other presentations
Patients may also present with concomitant pulmonary embolism (PE), with symptoms such as shortness of breath, chest pain, and dyspnoea. PE should always be considered in any patient with an acute DVT. In severe DVT, massive swelling can obstruct superficial venous return as well as arterial inflow, leading to a life- and limb-threatening condition known as phlegmasia cerulea dolens. The leg may be severely swollen, painful, and ischaemic. Most patients who present with superficial venous thrombosis (SVT) have a tender palpable cord under the skin. However, about one quarter of patients with signs and symptoms of SVT on examination will also be found to have DVT when ultrasound is performed.
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