My Leg Is Swollen!

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An 85-year-old woman, with a history of congestive heart failure, presented with right leg pain and swelling of 2 days’ duration. She had been hospitalized for pneumonia one week earlier. Her vitals on arrival were: Blood Pressure: 138/84 mmHg, Pulse Rate: 65 beats per minute, Respiratory Rate: 14 breaths per minute, Body Temperature: 37°C (98.6°F), Oxygen Saturation: 96%. On examination, her right calf was reddish, tender, edematous and 4 cm greater in circumference than the left when measured 10 cm below the tibial tuberosity. Her Wells’ Score for deep vein thrombosis (DVT) was 4 and suggested high-risk for DVT. Compression ultrasonography showed a thrombus in the popliteal vein. Enoxaparin (1 mg/kg, twice a day, SC) was started. No signs and symptoms of pulmonary embolism were observed. The patient was referred to a cardiovascular surgeon as an outpatient after discussion and confirmed understanding of discharge instructions.

Turkey
by Elif Dilek Cakal from Turkey.