Case Study: Painful Swelling in the Right Calf

Case Study: Painful Swelling in the Right Calf

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SF, a 63 year-old Caucasian female presents to the emergency department with painful swelling in her right calf. She reports right calf cramps for 7 days and severe pain for 2 days, making it very difficult to walk. She now notes redness and swelling in the leg. The patient denies recent leg trauma, but 2 years ago she fractured her right ankle while descending some stairs. She denies chest pain or shortness of breath.

Past medical history reveals hypothyroidism depression, fibrocystic breast disease and hypertension. She has 2 healthy daughters, father deceased (CHF, CAD, HTN), mother deceased from breast cancer.

SF appears healthy, well developed female, but is in mild distress due to calf pain. Physical examination was essentially normal except that the calf circumference of the RLE was larger than the LLE. There was some skin erythema without well demarcated borders, tender to palpation, and trace ankle edema of the RLE. Visible varicosities were present bilaterally. Pulses; were symmetric and full without bruits throughout. She was unable to weight bear on the right leg due to pain.

A duplex ultrasound of the right lower extremity was done but was suggested that a repeat ultrasound be done for positive confirmation. Coagulation studies were done with the Prothrombin time as 12 seconds and Partial Thromboplastin Time was 30.

1. What is the patient’s chief complaint? (3 points)

2. In her past medical history her father had three conditions, give the full name of each one. (3 points)

3. Identify 7 findings from the physical exam? (14 points)

4. What diagnostic tests were used and what is the purpose of these tests? (6 points)

5. What do the following mean RLE and LLE? (2 points)

6. What would you suggest is the diagnosis? (2 points)

7. She denies chest pain or shortness of breath. What is the significance of this? (2 points)

8. Choose 2 physical exam findings and discuss their relevance to your diagnosis. (4 points)