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Short answer question case series: evaluation of the swollen, blue extremity
  1. Josh Beck,
  2. Timothy B Jang
  1. Department of Emergency Medicine, David Geffen School of Medicine at UCLA, Harbor-UCLA Medical Center, Torrance, California, USA
  1. Correspondence to Dr Timothy Jang, Department of Emergency Medicine, Harbor-UCLA Medical Center, David Geffen School of Medicine at UCLA, 1000W Carson Ave, D-9, Torrance, CA 90509, USA; tbj{at}ucla.edu

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Case vignette

A 33-year-old man with a history of severe hypertension and recent cerebrovascular accident resulting in chronic left-sided weakness and decreased sensation presents with 3 days of painless swelling of his left leg. He is currently taking aspirin, labetalol, benazepril and ibuprofen. His vitals show a heart rate of 70 beats/min, blood pressure of 170/100 mmHg, respiratory rate of 18 breaths/min and a pulse oximetry of 98% saturation. On left lower extremity examination, he has 2+ oedema with palpable but diminished pulses, 4-second cap refill to his foot, decreased light touch and 2-point sensation to mid-thigh, 4/5 motor strength to the hip flexor and knee extensor, and 3/5 motor strength distal to the knee. The patient's visual examination is shown in figure 1.

Figure 1

Picture of patient's legs.

Key questions

  1. What is the differential diagnosis?

  2. How should this patient be evaluated?

  3. What are the emergency department (ED) management priorities in this patient?

  4. What is the appropriate disposition for this patient?

Discussion

1. Unilateral leg swelling has several common aetiologies, namely trauma, infection, lymphoedema and thrombosis. Other causes of leg swelling such as renal insufficiency and congestive heart failure typically cause bilateral leg swelling. However, none of …

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