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Chronic recurrent DVT

Redding SDR - MedPix (2005)

View Article: MedPix Image - MedPix Case

Affiliation: Uniformed Services University

ABSTRACT

Diagnosis: Chronic recurrent DVT

History: 32 y/o WF with a 4-day history of left leg pain beginning at mid-thigh level and edema below the level of the knee over the previous 24-hour period. She was feeling well prior to the onset of these symptoms. About 18 months earlier, the patient had been involved in a MVA, during which she sustained soft tissue trauma to the right lower leg, and multiple metatarsal fractures. A short cast was applied, and the patient was discharged from the hospital on crutches without RLE weight bearing. The patient returned one week later complaining about pain in the right calf and that the “cast was too tight”. The cast was removed and compression ultrasound confirmed DVT. The patient was started on Lovenox 1mg/kg SC q12h until PO anticoagulation with Coumadin was established. The patient remained on Coumadin for 4 months without any complications or recurrence. Prior to this current problem, the patient was fully ambulatory, there was no recent history of trauma to the left leg, and no other risk factors for DVT could be identified.

Findings: CXR – unremarkable, NAPD. Compression U/S – RLE: Normal, easily compressible hypoechoic veins with some posterior wall enhancement in proximal RLE. No evidence of venous distention. Compression U/S - LLE: Noncompressibility of common femoral vein with echogenic thrombus within the vein lumen consistent with chronic DVT.

Ddx: Chronic DVT, Acute DVT, Baker’s cyst, cellulitis, lymphedema, chronic venous insufficiency, superficial thrombophlebitis, popliteal venous or arterial aneurysm, enlarged lymph nodes compressing the veins, heterotopic ossification, hematoma, and muscle tears.

Dxhow: Compression Ultrasound

Exam: Well developed, well nourished 32 y/o WF in NAD. BP 122/78, Pulse 90 regular, RR 16 unlabored, Afebrile, Wt 126#, Ht 5’7". Pulse oximetry RA 99%, on room air. HEENT: exam unremarkable. Neck supple, nodes negative, no JVD or HJR, carotids equal w/o bruits, thyroid unremarkable. Lungs clear; no wheezing, rales, or rhonchi. No pericardial or pleural rubs. Cardiac: rhythm regular, S1S2 WNL, w/o S3, S4, or murmur. No peristernal heaves. PMI WNL. Abdomen soft, BS normoactive, nontender, no organomegaly or masses. Pelvic not performed. Rectal negative, stool hemoccult negative. Peripheral pulses good. 1-2+ edema LLE to level of knee; Homan’s positive on left; left calf tender; also tender left medial thigh to mid thigh level. RLE negative. No signs of varicose veins or venous insufficiency. Brief neuro exam unremarkable. CBC, Chemistries, UA, Coagulation studies all unremarkable.

No MeSH data available.


Compression U/S – RLE:  Normal, easily compressible hypoechoic veins with some posterior wall enhancement in proximal RLE.  No evidence of venous distention.
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MPX2418_synpic27251: Compression U/S – RLE: Normal, easily compressible hypoechoic veins with some posterior wall enhancement in proximal RLE. No evidence of venous distention.


Chronic recurrent DVT

Redding SDR - MedPix (2005)

Compression U/S – RLE:  Normal, easily compressible hypoechoic veins with some posterior wall enhancement in proximal RLE.  No evidence of venous distention.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=MPX2418&req=5

MPX2418_synpic27251: Compression U/S – RLE: Normal, easily compressible hypoechoic veins with some posterior wall enhancement in proximal RLE. No evidence of venous distention.

View Article: MedPix Image - MedPix Case

Affiliation: Uniformed Services University

ABSTRACT

Diagnosis: Chronic recurrent DVT

History: 32 y/o WF with a 4-day history of left leg pain beginning at mid-thigh level and edema below the level of the knee over the previous 24-hour period. She was feeling well prior to the onset of these symptoms. About 18 months earlier, the patient had been involved in a MVA, during which she sustained soft tissue trauma to the right lower leg, and multiple metatarsal fractures. A short cast was applied, and the patient was discharged from the hospital on crutches without RLE weight bearing. The patient returned one week later complaining about pain in the right calf and that the “cast was too tight”. The cast was removed and compression ultrasound confirmed DVT. The patient was started on Lovenox 1mg/kg SC q12h until PO anticoagulation with Coumadin was established. The patient remained on Coumadin for 4 months without any complications or recurrence. Prior to this current problem, the patient was fully ambulatory, there was no recent history of trauma to the left leg, and no other risk factors for DVT could be identified.

Findings: CXR – unremarkable, NAPD. Compression U/S – RLE: Normal, easily compressible hypoechoic veins with some posterior wall enhancement in proximal RLE. No evidence of venous distention. Compression U/S - LLE: Noncompressibility of common femoral vein with echogenic thrombus within the vein lumen consistent with chronic DVT.

Ddx: Chronic DVT, Acute DVT, Baker’s cyst, cellulitis, lymphedema, chronic venous insufficiency, superficial thrombophlebitis, popliteal venous or arterial aneurysm, enlarged lymph nodes compressing the veins, heterotopic ossification, hematoma, and muscle tears.

Dxhow: Compression Ultrasound

Exam: Well developed, well nourished 32 y/o WF in NAD. BP 122/78, Pulse 90 regular, RR 16 unlabored, Afebrile, Wt 126#, Ht 5’7". Pulse oximetry RA 99%, on room air. HEENT: exam unremarkable. Neck supple, nodes negative, no JVD or HJR, carotids equal w/o bruits, thyroid unremarkable. Lungs clear; no wheezing, rales, or rhonchi. No pericardial or pleural rubs. Cardiac: rhythm regular, S1S2 WNL, w/o S3, S4, or murmur. No peristernal heaves. PMI WNL. Abdomen soft, BS normoactive, nontender, no organomegaly or masses. Pelvic not performed. Rectal negative, stool hemoccult negative. Peripheral pulses good. 1-2+ edema LLE to level of knee; Homan’s positive on left; left calf tender; also tender left medial thigh to mid thigh level. RLE negative. No signs of varicose veins or venous insufficiency. Brief neuro exam unremarkable. CBC, Chemistries, UA, Coagulation studies all unremarkable.

No MeSH data available.