Case history
Case history
A 45-year-old woman presents with complaints of heaviness and fatigue in her legs. She does not experience the symptoms when she first awakens, but they become more noticeable and prominent as the day progresses and with prolonged standing. When she is standing for most of the day she notes swelling in both legs. The symptoms are concentrated over her medial calf, where she has prominent tortuous veins. She first noted dilated veins about 20 years ago when she was pregnant. Initially they did not cause her any discomfort but they have progressively enlarged and over the past 10 years have become increasingly painful. She recalls that her mother had similar veins in her legs.
Other presentations
Patients may also present with thrombophlebitis, bleeding, and venous ulceration. Thrombophlebitis presents as severe pain and erythema, hyperpigmentation, and hardening of the vein. It is more correctly called superficial venous thrombosis and is on the venous thromboembolism (VTE) spectrum; there is a risk of developing deep vein thrombosis even with the use of anticoagulation.[3]
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