lower venous case studies

A 52-year-old woman with a painful left leg is seen by her physi cian. Physical examination reveals a red swollen leg with “tough cords” running just below the skin surface. B-mode examination shows dilated, superficial vessels filled with low-level echoes. These vessels are identified as superficial because their course lies within the first fascial plane. The deep veins of the upper and lower leg are compressible and show normal flow without evidence of internal thrombus. What is the most likely diagnosis?

superficial thrombophlebitis

A 32-year-old woman presents to the emergency department with excruciating right lower extremity pain for the past 3 hours. Patient history includes a morbid increase in body habitus, sedentary life style, and mild to moderate right lower extremity pain for the past week that has gotten much worse within the past 3 hours. The clinician notes a bluish tinge to the massively enlarged leg. Her toes and foot are becoming increasingly white. What is the most likely diagnosis?

phlegmasia alba dolens

A 39-year-old man presents for a bilateral LEVD for leg pain that has persisted for the past month. Patient history includes diabetes mellitus, hypertension, and hyperlipidemia. This patient is noncom pliant and does not take medications, including insulin, as directed. Sonographic findings included fully compressible veins bilater ally with adequate color Doppler. Pulsed wave Doppler revealed halting proximal compressions with an augmented distal compression bilaterally. What is the most likely diagnosis?

neuropathy from diabetes

A 63-year-old man presents to the emergency department with bilateral lower extremity edema and shortness of breath. Patient history is limited because of lack of medical records, and he appears very confused. Sonographic findings for bilateral LEVD revealed fully compressible veins bilaterally, with adequate color Doppler. Pulsed wave Doppler revealed halting proximal compres sions with an augmented distal compression bilaterally. Pulsed wave imaging also noted a lack of respiratory phasicity with very pulsatile veins bilaterally. What is the most likely diagnosis?

congestive heart failure

A 42-year-old man presents to the emergency department for right lower extremity pain and edema. Patient history includes smok ing 3 packs of cigarettes per day, alcohol abuse, and diabetes. He is noncompliant in his diabetes monitoring and treatment, partly because he is homeless. Right LEVD revealed intraluminal echoes in the proximal femoral vein with lack of color flow, which were difficult to identify, and a noncompressible trifurcation that is small and hyperechoic. Proximal compressions revealed that blood flow could not be halted. On locating difficult-to-identify intraluminal echoes in the proximal femur, distal compressions were ceased. What is this patient’s most likely diagnosis?

DVT with venous insufficiency