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SONO case series: 39-year-old man with leg swelling and pain
  1. Nancy Anaya,
  2. Kavita Gandhi,
  3. Sally Graglia
  1. Emergency Medicine, University of California San Francisco, San Francisco, California, USA
  1. Correspondence to Dr Nancy Anaya, Emergency Medicine, University of California San Francisco, San Francisco, CA 94143, USA; nancy.anaya{at}

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Case presentation

A 39-year-old man presented to the ED with 1 week of right lower extremity (RLE) swelling, redness and pain. His pain is currently rated at 10/10. His pain began after a long run. He denies trauma during this run. He was recently treated with an antibiotic for a skin infection. He denies any fevers, recent surgeries or hospitalisations. He denies any recent long car trips or flights.

The patient denies any medical history. He has never had any surgeries. He is not taking any medications and has no allergies.

Physical examination

On examination, the patient’s BP is 130/85 mm Hg with a pulse of 83. He is afebrile with a temperature of 36.5°C. He is breathing 18 times/min and has an oxygen saturation of 98% on room air.

The patient is a middle-aged man in no acute distress. His RLE exhibits erythematous streaking, extending from medial inguinal area down to his medial malleolus, along the distribution of the saphenous vein. The area is not warm to touch. He has tenderness to palpation of his RLE. He has normal dorsalis pedis and posterior tibial pulses. He has full range of motion at the hip, knee and ankle. He has no swelling or redness to these joints. His sensation in the RLE is intact. His left lower extremity has a normal examination.

Laboratory data

The patient’s complete blood count and metabolic panel are normal.

Point-of-care ultrasound (POCUS) of RLE from common femoral vein (CFV) to popliteal vein (PV) is performed.

What are the indications for a POCUS deep venous thrombosis examination?

Patients who have asymmetrical swelling, pain, or redness of their lower extremities, or concerning history or risk factors for deep venous thrombosis (DVT), may benefit from a bedside DVT examination. Recent meta-analysis showed that emergency medicine providers can perform this examination well on ambulatory patients with 96% sensitivity and 96% specificity after training and practice.1–3

What is normal anatomy and how do you perform this examination?

A high …

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  • Handling editor Simon Carley

  • Contributors NA and coauthor KG wrote the article, provided edits and acquired the images.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.