DVT left leg with suspected PE with secondary varicose veins
The patient had painful swelling left leg for the past 8 months. This was proven on colour Doppler study to be Ilio-femoral DVT. He was on treatment for DVT but unfortunately defaulted on a number of occasions not taking the medical advise offered to him.
Recently he had shortness of breath which was persistant.
The patient has been on reasonably good health with no cardiac or respiratory problems in the past. There is no history of diabetes
The ptient was in good general health and not in obvious pain. The leg showed no swelling. There were no grossly dilated veins on the left leg. Normal pulsations were present at the ankle. There was an area of discolouration above the left medial malleolus. There were no ulcers.
Hb – 13.7 gm% TLC – 11700 μ/l Platelets – 288000 μ/l
RBS – 93 mg% Urea – 17 mg% Createnine – 0.7 mg%
Na – 137 meq/l K – 4.1 meq/l PT – 19.3/12 sec
PTT – 28/28 sec
CXR – WNL
ECG – WNL, no right heart strain
Colour Doppler study –
It showed ilio-femoral DVT on the left leg with partial rechanalization. There was incompetence of the long saphenous vein at the SFJ and there were two large perforators in the leg which were responsible for the discolouration and impending ulceration.
The patient was treated conservatively with foot elevation, stockings and anticoagulation. The main reason to admit him was to exclude the possibility of PE secondary to DVT and to monitor any episodes of breathlessness while in hospital. Secondary varicose veins are never treated surgically.
Condition on discharge
Mostly unchanged. The leg was soft with minimal swelling. The dermatitis was present on the medial aspect above the malleolus.
Advise on discharge
(Dr. Jaisom Chopra)
Consultant Vascular Surgeon