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  #1  
Old 04-28-2012
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Vascular Tender Swollen Calf after Embolectomy!

An 88-year-old male complains of severe right calf pain several hours after undergoing a right femoral artery embolectomy. He also complains of a burning sensation in his posterior right leg. He has a long history of atrial fibrillation and hypertension. His past medical history also includes stroke, bleeding duodenal ulcer, diabetes mellitus and diabetic nephropathy. On physical examination, his blood pressure is 160/70 mm Hg and his heart rate is 100 per minute and irregular. His right calf is swollen, tense and exquisitely tender; the pain is worsened by passive extension of the right knee. Dorsalis pedis and posterior tibial pulses are palpable in the bilateral lower extremities. Which of the following is the most likely cause of this patient's symptoms?

A. Recurrent embolism
B. Venous thrombosis
C. Soft tissue swelling
D. Bone infarction
E. Anaerobic infection
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  #2  
Old 04-28-2012
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this is compartment syndrome , soft tissue swelling is the ANS
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Old 04-28-2012
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I think B. Venous thrombosis is the answer
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Old 04-28-2012
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compartment syndrome due to ischemia of the calf?
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Old 04-28-2012
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Quote:
Originally Posted by chienpolska View Post
compartment syndrome due to ischemia of the calf?
The pt in the question underwent embolectomy for an arterial thrombus and had ischemia for some time. After the embolectomy, there will be repurfusion injury leading to swelling of the soft tissue which can cause compartment syndrome.
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Old 04-28-2012
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Answer is C
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Old 04-28-2012
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I thought in bleeding peptic ulcer with afib patient anticoagulent are withdrawn...moreover immboilization post surgery ...previous h/o embolism all add up to high risk for DVT..so went with answer B. Also homans sign was positive ......so why not answer B??
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Old 04-28-2012
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Quote:
Originally Posted by confident View Post
I thought in bleeding peptic ulcer with afib patient anticoagulent are withdrawn...moreover immboilization post surgery ...previous h/o embolism all add up to high risk for DVT..so went with answer B. Also homans sign was positive ......so why not answer B??
Because:
1. severe right calf pain several hours after undergoing a right femoral artery embolectomy.>>>>>>>Reperfusion>>>>third spacing>>>>>edema & swelling of soft tissue>>>>>compartment syndrome.

2. He also complains of a burning sensation in his posterior right leg.>>>>>>nerve ischemia due to compression (does not happen in DVT)

3. His right calf is swollen, tense and exquisitely tender >>>>DVT does not lead to "tense and exquisitely tender" just tenderness.

4. the pain is worsened by passive extension of the right knee >>>>>>This is not the Homans' sign Read below>>>>>

Quote:
In medicine, Homans' sign is a sign of deep vein thrombosis (DVT). A positive sign is present when there is pain in the calf or popliteal region with examiner's abrupt dorsiflexion of the patient's foot at the ankle while the knee is fully extended. [1][2] This sign is frequently elicited in clinical practice because of the ease of use, although it is falling into disfavor because of poor reliability and because it is frequently positive in individuals without DVT. A positive Homans' sign does not positively diagnose DVT (poor positive predictive value), and a negative Homans' sign does not rule out the DVT diagnosis (poor negative predictive value).
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Thanks for detail explanation@ novobiocin....i should never miss this q now
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I think the answer is B. Venous thrombosis
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Old 04-29-2012
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It's not venous thrombosis . One reason is pain in thrombosis is rarely severe or sudden in onset as mentioned here . Novobiocin has nicely expl up.
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Old 07-11-2012
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Thanks! Now I won't forget this concept.
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