A Case Of A Swollen Leg

Abstract

HISTORY: Patient is an 83 year old female with a history of hypertension and hyperlipidemia that originally presented to vascular clinic with 7 months of left lower extremity swelling and numbness. At that time, she first noticed numbness in her left foot that extended up to mid calf. She also mentioned that in particular, her 3rd, 4th, and 5th toes felt numb and it made it difficult to walk. She denied any injuries to her left lower leg. PHYSICAL EXAMINATION: General: Well appearing in no acute distress, AO x 3. Right knee exam: Normal. Left knee exam: Mild swelling in popliteal fossa. Normal ROM of left knee. No tenderness to palpation along joint lines. Left lower extremity: 1+ edema present to the knee, bluish discoloration of toes on left foot. Unable to fan out 3rd, 4th, and 5th digit. No tenderness to palpation. Right lower extremity: Normal exam DIFFERENTIAL DIAGNOSIS: 1. Popliteal artery/nerve entrapment. 2. Peroneal nerve dysfunction. 3. Baker's cyst causing compression. 4. Cystic adventitial disease. 5. DVT. 6. Arterial thrombosis. 7. Popliteal fossa mass. TEST AND RESULTS: ABI @ DP was 0.37 indicating severe occlusive disease. ABI @ PT was 0.44 indicating severe occlusive disease. MRI revealed extensive cystic structure which occluded a short portion of popliteal artery. FINAL WORKING DIAGNOSIS: Cystic adventitial disease resulting in compression/occlusion of popliteal artery. TREATMENT AND OUTCOMES: We saw this patient in sports clinic to discuss ultrasound guided aspiration of the cyst that was compressing popliteal artery. Initial procedure resulted in removal of 5 cc of thick, gelatinous fluid that was identified as a sparse mucoid matrix. During the procedure, we were able to watch the popliteal artery begin pulsing again. Patient was able to move toes and had improved sensation immediately after procedure. Fatigue in left lower leg has been slowly improving. Plan is to repeat aspiration in an attempt to fully drain entire cystic structure.