Bedside ultrasonography in diagnosing bilateral femoral arterial occlusion in an elderly patient with acute limb ischemia

Abstract

Non-traumatic acute limb ischemia is a critical vascular emergency that can lead to limb loss or life-threatening complications1. It is predominantly caused by arterial occlusions due to thrombi or emboli. Our report highlights the pivotal role of bedside ultrasonography in the emergency diagnosis of acute limb ischemia, exemplified by a case of bilateral femoral arterial occlusion. An 83-year-old woman with a medical history of atrial fibrillation, not on anticoagulation therapy, presented to the emergency department with increased right knee pain and dizziness. Initial examination revealed palpable peripheral pulses and sensitivity on knee palpation without overt signs of ischemia. However, subsequent systemic examination, prompted by the patient’s worsening agitation and pain, revealed coldness, pallor, and weakened pulses in both lower extremities. Bedside ultrasonography confirmed the presence of thrombi in both femoral arteries. The patient underwent successful emergency thrombectomy and was discharged with full recovery after appropriate management of atrial fibrillation. This case underscores the importance of vigilant systemic re-examination and the utility of bedside ultrasonography in the rapid diagnosis of acute arterial occlusion, particularly in patients with risk factors such as atrial fibrillation. Emergency physicians should consider acute limb ischemia in the differential diagnosis of patients presenting with non-specific symptoms like dizziness and localized pain, especially when coupled with a history of cardiovascular risk factors.