Swelling Of Left Leg Research Articles

A rare case of arterio-venous malformation in the lower limb

Aim of the study: To report a case of massive enlargement of left lower limb due to diffuse microscopic arteriovenous malformation. Place of Study: A seventeen old girl from, Mysore, Karnataka, India. Period of Study: During the month of June - July 2014. Case Report: A 17 year old female came with history of diffuse swelling of left leg and foot and skin bluish discolouration of the lateral aspect of left thigh, since birth. The lateral 4 toes of left foot are enlarged having circumference of 5 to 6cm. The middle toe was much longer than other toes. The big toe was smaller in size. Patient has pain while walking and subsides on taking rest. She was the only child born to non consanguineous couple. There was no history of filariasis in the family. Observations: On examination there was generalized massive swelling of the left leg, left foot and lateral four toes in left foot. Big toe is not involved. There was bluish discolouration of the skin on the lateral aspect of left thigh. Discussion: The present study was correlated and well compared with available literature. Conclusion: This is a case of arteriovenous malformation

Deep vein thrombosis due to continuous prone positioning after retinal detachment surgery

In March 2014, a 56-year-old woman without previous underlying disease underwent encircling scleral buckling, 20-gauge pars plana vitrectomy, cryotherapy around a retinal tear, and gas-fluid exchange with 15% perfluoropropane flush for upper rhegmatogenous retinal detachment of the left eye. However, she developed progressive left leg swelling, pain, warmth, and redness, associated with difficulty in elevating her left leg after continuously maintaining a prone head position when either lying down or sitting for 2 days. When she arrived at the emergency room, she had an elevated d-dimer level. After undergoing Doppler ultrasound imaging, she was diagnosed as having deep vein thrombosis of the left leg. She received anticoagulation therapy with enoxaparin and warfarin overlapping for 7 days. The edema, pain, and paresthesia of her left leg were relieved. However, because of the risk of bleeding with anticoagulation drug usage, the patient needed to be monitored for 6 months. Prone positioning for gas tamponade is important for anatomic and functional success in retinal detachment surgery; however, timely walking and rest between periods of continuous prone positioning should be encouraged to prevent deep vein thrombosis and other impaired circulation-related complications.

Spontaneous Iliac Vein Rupture

Spontaneous iliac vein rupture (SIVR) is a rare entity, which usually occurs without a precipitating factor, but can be a life-threatening emergency often requiring an emergency operation. This is a case report of SIVR in a 62-year-old female who presented to the emergency room with left leg swelling. Workup with contrast-enhanced computed tomography revealed a left leg deep vein thrombosis with May-Thurner syndrome and a hematoma in the pelvic cavity without definite evidence of arterial bleeding. She was managed conservatively without surgical intervention, and also underwent inferior vena cava filter insertion and subsequent anticoagulation therapy for pulmonary thromboembolism. This case shows that SIVR can be successfully managed with close monitoring and conservative management, and anticoagulation may be safely applied despite the patient presenting with venous bleeding.

Deep Venous Thrombosis of the Leg, Associated with Agenesis of the Infrarenal Inferior Vena Cava and Hypoplastic Left Kidney (KILT Syndrome) in a 14-Year-Old Child.

Agenesis of the inferior vena cava (IVC) is a rare anomaly which can be identified as incidental finding or can be associated with iliofemoral vein thrombosis. IVC agenesis has a known association with renal anomalies which are mainly confined to the right kidney. We describe a case of a 14-year-old male who presented with left leg swelling and pain. Ultrasonography confirmed the presence of left leg deep vein thrombosis (DVT). No underlying hematologic risk factors were identified. A CT scan was obtained which demonstrated absent infrarenal IVC and extensive thrombosis in the left deep venous system and development of collateral venous flow into the azygous/hemiazygous system, with extension of thrombus into paraspinal collaterals. An additional finding in the patient was an atrophic left kidney and stenosis of an accessory left renal artery. Agenesis of the IVC should be considered in a young patient presenting with lower extremity DVT, especially in patients with no risk factors for thrombosis. As agenesis of the IVC cannot be corrected, one should be aware that there is a lifelong risk of lower extremity DVT.

PMM.85 Radiation considerations for catheter directed thrombolysis in iliofemoral thrombosis n pregnancy

BackgroundVenous thromboembolism remains the direct cause of maternal death in the UK. Current Royal College of Obstetricians and Gynaecologist’s guidelines for confirmed deep vein thrombosis (in acute maternal collapse) carry...

Successful thrombolysis of renal allograft venous thrombosis – A case report

Renal allograft venous thrombosis is a rare but catastrophic complication resulting in graft failure. A 55-year-old male underwent live related renal transplantation. Donor's right kidney was placed in recipient's left iliac fossa. Graft renal artery was anastomosed to the left internal iliac artery. Graft renal vein was anastomosed to the left external iliac vein in a side to side fashion. He was discharged with a serum creatinine of 0.9 mg. Four weeks after transplantation patient was readmitted with anuria for 6 h and swelling of left leg for 1 day. Doppler study showed extensive venous thrombosis extending from left femoral, external iliac veins with total occlusion of allograft vein. Renal arterial diastolic flow was absent. Blood urea was 36 mg/dl and creatinine was 2.2 mg/dl. A fogarty's catheter was inserted in the popliteal vein and venogram was performed to outline the extent of thrombus. Thrombosuction followed by In situ thrombolysis with streptokinase and heparin were carried out. His renal parameters and urine output dramatically improved following our intervention. He was discharged with the creatinine of 0.8 mg/dl. Salvage of the allograft in renal vein thrombosis is possible if early diagnosis and aggressive thrombolytic therapy are instituted.

A morbid case of leg swelling

A 24-year-old man without past medical history complains of left leg swelling and pain. Six weeks ago, he was kicked playing football and developed a non-displaced fracture of his mid-left...

Duplex Ultrasound in the Diagnosis of Lower-Extremity Deep Venous Thrombosis

A 26-year-old woman presented with progressive swelling and pain of the left leg within 2 months after switching to a different oral contraceptive preparation. On examination, she had marked edema and erythema of the leg from the calf to the thigh with significant tenderness to palpation. Pedal pulses were intact. The right leg was normal. Lower-extremity venous duplex ultrasound (VDUS) with B-mode compression maneuvers and Doppler evaluation was performed, and she was found to have an acute deep venous thrombosis (DVT) of the left leg that extended from the common iliac vein into the left calf (Figure 1A–1E). Figure 1. Acute iliofemoral deep venous thrombosis (DVT) in a 26-year-old woman with left leg swelling. A , B-mode image of a dilated external iliac vein (arrow) next to the external iliac artery (arrowhead). Intraluminal echoes are present, consistent with thrombus. B , Nearly complete loss of compressibility of the external iliac vein, consistent with acute DVT. C , Spectral Doppler waveform analysis with absent venous flow in the thrombosed and occluded external iliac vein (EIV). Lt DIST indicates left distal. D , B-mode image of acute DVT involving the profunda and femoral confluence into the common femoral vein. E , Color-flow Doppler image demonstrating absent flow in the common (CFV) and femoral (FV) vein and minimal flow in the profunda femoral vein (PFV; arrow). VDUS combines 2 components to assess for DVT: B-mode or gray-scale imaging with transducer compression maneuvers and Doppler evaluation consisting of color-flow Doppler imaging and spectral Doppler waveform analysis.1 The technique of compression B-mode ultrasonography for the diagnosis of DVT was first described by technologist Steve Talbot in 1982 and has subsequently been refined to become the diagnostic standard.2 B-mode imaging is used while the lower-extremity veins are compressed along their length with the ultrasound probe …

<I>Nocardia brasiliensis</I> による膿瘍型皮膚ノカルジア症と考えた1症例

A 58-year-old woman, who had write infull (ITP) and angina, developed a rash similar to an insect bite on the left Achilles tendon one week before visiting our hospital. The rash evolved into pustule. Three or 4 days later she had redness and swelling on her left leg, which was pain full.She went to a clinic, where she was given cefdinir (CFDN) and referred to our hospital.When she came to our hospital, she had an abscess on her left heel, and linear redness and heat along lymph ducts in her left leg and lymph node swelling in her left groin.We diagnosed bacterial lymphangitis, and gave her cefcapene (CFPN-PI) and gentamicin (GM) ointment. Six days later, she recovered.Later abscess culture yielded an organism which was suspected to be Nocardia sp. We identified the organism as Nocardia brasiliensis and diagnosed abscess-type cutaneous nocardiosis. We administered sulfametthoxazole / trimethoprim for one week and checked her whole body on CT, which revealed no lesions.This case was considered to be cutaneous nocardiosis, for which beta-lactam antimicrobial drug or external application of GM ointment would be effective, and abscess-type cutaneous nocardiosis, which recovered with medical treatment for a general bacterial infection was suggested.

Refractory Colitis with Skin Manifestations

Purpose: A 28-year-old male with a past medical history of Crohn's colitis presents with worsening abdominal pain and diarrhea. His index colonoscopy revealed pancolitis but later showed patchy colitis with sparing of the rectum and ileum. His symptoms were refractory to adalimumab and infliximab with low-dose 6-MP. The patient was positive for JC virus antibody, so natalizumab was deferred. He was started on ustekinumab and low-dose methotrexate with minimal response and developed weekly muscle swelling with associated pain and redness. Symptoms did not improve with prednisone taper. The patient was admitted for expedited management. Exam revealed abdominal tenderness without rebound as well as painful left forearm and right leg swelling. Initial labs yielded a normal WBC, mild microcytic anemia, and elevated inflammatory markers (CRP 72.5, ESR 40). Metabolic and liver panels and albumin were normal. Infectious stool studies were negative. Flexible sigmoidoscopy biopsies showed inflammation but no CMV infection. The patient was started on methylprednisolone 40mg IV daily and natalizumab 300 mg IV q4 weeks and placed on parenteral nutrition. Dermatology performed punch biopsy of a cellulitic plaque on the left forearm which revealed subcutaneous septal leukocytoclastic vasculitis (LCV). A subsequent painless rash developed, which demonstrated LCV on biopsy. Lyme, parvovirus, and hepatitis serologies; anti-Streptolysin O titers; ANCA and complements C3 and C4 were all unremarkable. Urine protein-to-creatinine ratio was normal. The patient was referred for subtotal colectomy with end ileostomy, but he wished to defer surgery. His symptoms gradually improved, and he was transitioned to an oral diet and prednisone and discharged home on natalizumab. Conclusion: LCV is believed to be an immune complex disorder that can be triggered by various drugs, infections, malignancies, and systemic and autoimmune disorders. In this case, the patient's LCV was felt likely due to his inflammatory bowel disease or possibly medication (e.g., methotrexate). The atypical appearance of his initial rash was felt due to the subcutaneous location of his LCV. LCV is less frequently seen in IBD compared to other skin manifestations such as erythema nodosum or pyoderma gangrenosum. Skin lesions of LCV usually spontaneous self-resolve or can be treated with corticosteroids, dapsone, colchicine, or immunosuppressive agents.

Extensive air dissection due to necrotizing fasciitis

A 34-year-old woman presented to our clinic with left thigh painful disability for 7 days. She suffered from dog bite of left thigh about 4 weeks ago status post-wound debridement and just discharged from other hospital 2 weeks ago. Physical examination revealed erythema, swelling, local heat and tenderness of left upper leg with palpation. Laboratory studies revealed elevated C-reactive protein and minimal leukocythemia with a white blood cell count of 10.18 × 103 …

Leg Pain in a Patient with Myasthenia Gravis

A 79-year-old male with myasthenia gravis on chronic prednisone therapy presented with progressive left leg pain and swelling and nonproductive cough for one month. Physical examination was significant for multiple, irregular, tender areas of induration in his bilateral lower extremities without overlying erythema. Laboratory data were significant for a white cell count of 12,400/cmm. MRI showed multifocal abscesses in his bilateral lower extremities within the muscle beds, which were more significant on the left (Fig. 1). He underwent ultrasound-guided drainage of the large abscesses. Cultures grew Nocardia pseudobrasiliensis sensitive to moxifloxacin. CT chest showed bilateral pleural effusions and ground-glass opacities in the right upper lobe, suggesting pulmonary nocardiosis with dissemination secondary to immunosuppression from chronic steroid use. The patient was started on moxifloxacin with a plan to treat for 12 months. Figure 1. MRI of the left leg demonstrating multifocal abscesses in multiple muscular beds. The majority of patients with nocardial infection are immunocompromised; the most common causes are glucocorticoid therapy, malignancy, organ transplantation, and HIV infection. Disseminated nocardial infection typically presents with deep abscess especially in the lower extremities or CNS.1 Treatment requires a long course of therapy: 6 months for pulmonary or systemic nocardiosis and at least 12 months for immunocompromised patients.2 Suspect norcardiosis in patients with CNS, soft tissue, or cutaneous lesions and a concurrent pulmonary process.

Intraosseous Lipoma of Distal Tibia

The intraosseous lipoma is a rare primary benign tumor of the bone. It consists of mature adipose tissue containing bony trabeculae. It is a radiographic illusion; computerized tomography and histopathological examination is required for its confirmation. We here in report a case of rare localization of intraosseous lipoma of distal tibia in a 38 year old female presented with pain and swelling in left leg. Treatment was done with extended curettage and filling the cavity with cancellous bone graft and calcium triphosphate with satisfactory outcome.

Tuberculous osteomyelitis in Job syndrome

Job syndrome (JS) is a rare primary immunodeficiency disorder characterized by the triad of raised serum immunoglobulin E levels, recurrent skin and pulmonary infections. A 6-year-old boy presented with the characteristic triad of JS and left leg swelling, which on evaluation was found to be tuberculous osteomyelitis. JS being an immunocompromised state can predispose to tuberculous infections and one has to be vigilant enough for early diagnosis and treatment to prevent deformity.

Relapse of primary testicular non-Hodgkin's lymphoma detected by 18F-FDG-PET/CT

We report the case of a 62-year-old male with a history of primary testicular non-Hodgkin's lymphoma, treated with orchidectomy. After 14 months, the patient developed left leg swelling and pain, and was diagnosed and treated as having leg vein thrombosis. 18F-FDG-PET/CT showed a relapse of testicular lymphoma in the cutaneous muscle tissue of the left leg.

Cytodiagnosis of Pilomatrixoma from an Uncommon Site with Unusual Presentation

Pilomatrixoma or pilomatricoma is an uncommon benign tumor of hair matrix origin, which most commonly occurs in the head and neck region and upper extremities. In this study, we report a case of pilomatrixoma of a 35-year-old female presenting with left-leg swelling with surface ulceration, clinically thought to be malignant. Fine-needle aspiration cytology (FNAC) of the lesion showed clusters of basaloid cells with round to ovoid nuclei, nucleated squamous cells, and anucleated squames and clusters of shadow cells. Acytological diagnosis of pilomatrixoma was made. Subsequent surgical excision and histopathological examination confirmed the diagnosis. This case highlights a rare site of presentation and the role of FNAC in preoperative diagnosis of this benign tumor for proper management.

57-Year-Old Woman With Acute Lower Extremity Pain and Swelling

A 57-year-old postmenopausal woman presented to our emergency department with a 1-day history of left leg pain, redness, and swelling. She reported no chest pain or shortness of breath. During the previous week, she made several car trips, each lasting 3 hours. Her medical history was remarkable for a left femoral and popliteal deep venous thrombosis (DVT) after breast reduction surgery during the previous year, which was treated with 1 week of subcutaneous low-molecular-weight heparin therapy and 6 months of oral warfarin therapy. She also had a history of hyperlipidemia, allergies, gastroesophageal reflux, and depression. She denied using tobacco or illicit drugs. Breast, cervical, and colon cancer screening were current and unremarkable. Daily oral medications were atorvastatin, sertraline, montelukast, and pantoprazole. She reported no family history of DVT.

Fibrous dysplasia of bone associated with soft-tissue myxomas as well as an intra-osseous myxoma in a woman with Mazabraud's syndrome: a case report

IntroductionMazabraud's syndrome is a rare but well-described disorder characterized by fibrous dysplasia in single or multiple bones associated with one or more soft-tissue myxomas. In this report, we describe what is, to the best of our knowledge, the first case involving an intra-osseous myxoma. This finding supports, and could provide new insight into, the pathological association between fibrous dysplasia and myxomas.Case presentationIn this report, we describe the case of a 49-year-old Caucasian woman known for years to have fibrous dysplasia in the left femur and tibia who presented with progressive pain in her left leg and soft swelling in the left quadriceps region. After surgical intervention with excision of the soft-tissue mass, the diagnosis of Mazabraud's syndrome was confirmed. During follow-up, our patient presented with a painless mass located on the lateral side of the left knee, next to a second, intra-osseous lesion with the same characteristics in the left lateral tibial plateau. The histopathological examination was consistent with a soft-tissue intra-osseous myxoma.ConclusionIn the international literature, 67 cases of Mazabraud's syndrome have been described so far.To our knowledge, the present case report is the first to describe the combination of polyostotic fibrous dysplasia and intra-muscular as well as intra-osseous myxoma.

Late septic hip dislocation with multifocal osteomyelitis and malaria: a case report.

A 9-year-old boy presented with high-grade fever associated with pain and swelling in right hip and left leg of 1-week duration. Pus was found on diagnostic aspiration of the right hip joint. Emergency arthrotomy was performed through anterior approach with drill holes in proximal femur and culture showed MRSA. Intravenous antibiotics were given for 4weeks. Patient symptomatically improved in immediate postoperative period and in bed hip mobilization was started. On eighth postoperative day, child developed high-grade intermittent fever with chills and rigors and diagnosed as plasmodium falciparum malaria. Fever subsided with antimalarial treatment. On twenty-first day, patient complained pain in right hip and X-ray showed posterior hip dislocation with osteomyelitis of proximal femur. Closed reduction and hip spica application was done under general anesthesia. At follow-up, the clinical result was fair with resolution of infection and stiff hip.

A Case of Lower Extremity Venous Thrombosis in the Pediatric Emergency Department

Unilateral calf swelling and pain is not a common complaint in the pediatric emergency department. We present a case of a 17-year-old adolescent boy with no past medical history who presented with left leg swelling and pain while taking prednisone and isotretinoin. He was found to have an extensive occlusive thrombus throughout the deep venous system in his left leg. He was later diagnosed with May-Thurner syndrome, an anatomic variant in which the right iliac artery compresses the left iliac vein. We review the differential diagnosis, diagnostic workup, and initial ED management of deep venous thrombosis and provide a brief discussion of May-Thurner syndrome and the association of isotretinoin and vascular thrombi.