Poster 124: Deep Venous Thrombosis Masquerading as Neurogenic Claudication: A Case Report

Abstract

Setting: Outpatient physiatric practice. Patient: A 70-year-old male neurologist. Case Description: A 70-year-old male neurologist was referred to physiatry by an orthopedist, requesting nonsurgical management of neurogenic claudication. The patient complained of anterolateral left calf pain that was worse with ambulation. The orthopedist had obtained lumbar magnetic resonance imaging (MRI), which showed severe spinal stenosis at L3-4 and moderate spinal stenosis at L4-5. But physiatric physical exam revealed tenderness to palpation of the left proximal calf and the symptoms were not exacerbated by lumbosacral extension. Also, there were no motor, sensory, or reflex deficits. He was sent for lower-extremity Dopplers to rule out a deep venous thrombosis (DVT). The Dopplers revealed an acute left popliteal DVT. Assessment/Results: A left lower-extremity DVT was diagnosed as the cause of his presenting symptoms. He was treated with anticoagulation, with an excellent outcome. Discussion: As physiatrists become increasingly specialized, we must remember that life-threatening medical conditions may present similarly to common musculoskeletal and neurologic conditions. The case also excellently illustrates the importance of performing a careful history and physical exam, rather than relying primarily on diagnostic testing such as MRI. Specifically, in this case, an orthopedist and a neurologist had assumed, based on MRI findings, that the symptoms were due to spinal stenosis. Failure to properly diagnose the DVT could have led to an unnecessary spine surgery or, more acutely, could have led to life-threatening complications of an untreated DVT. Conclusions: Life-threatening medical conditions such as DVT can masquerade as common musculoskeletal and neurologic conditions seen in the outpatient physiatry setting. A careful history and physical exam is crucial prior to attributing symptoms to abnormalities found on MRI.