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Leg Edema

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History of Present Illness:

  • A 62-year-old male presents to the ED for left ankle swelling.  He is on chemotherapy for lymphoma and his oncologist sent him to the ED to rule out DVT.
  • He denies prior leg edema or history of DVT/PE and has no fever, chest pain or SOB

Vital Signs & Physical Exam:

  • Vital signs are normal.
  • Exam is normal except for mild swelling of the left foot and ankle.  (See image)

 

Initial Differential Diagnosis:

  • DVT
  • Cellulitis
  • Gout
  • CHF
  • Hypoalbuminemia
  • Venous insufficiency
  • Lymphatic obstruction

Initial Diagnostic Testing:

  • CBC shows mild pancytopenia.
  • BMP and LFTs are normal.
  • Leg duplex is negative for thrombosis or Baker’s cyst or other pathology

QUESTIONS:

  1. What does the case image show?  (click two times to enlarge)
  2. What should you do next?  
  3. Where can one get a quick refresher on this topic?  

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ANSWERS:

  1. What does the case image image show?  The image shows mild prepedal edema
  2. What should you do next?  and consult   .
  3. Where can one get a quick refresher on this topic?  See yellow highlighted area below from purple book above…

1-Minute Consult on the EM topic for this case from the Emergency Medicine 1-minute Consult Pocketbook

 

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CASE CONCLUSION: We’ll just have to see

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