Author: Izabella K. Orban / Editor: Nick Tilbury / Reviewer: Ciaran Mackle / Codes: PC1, SLO1, SLO2, TC1 / Published: 04/03/2021 / Reviewed: 24/02/2025
A 70-year-old female presents to the emergency department (ED) with non-traumatic calf pain and swelling over the last 24 hours. She tells you the pain has steadily got worse and she is now completely unable to weight-bear. She tells you that something is just “not right”.
Her past medical history includes HTN and previous DVT and PE. She also has an IVC filter in-situ.
She is taking Rivaroxaban and Amlodipine and has been compliant with her medication. There is a strong family history of multiple blood clots in first degree relatives.
She lives with her husband and was independently mobile before this pain started. She has never smoked.
Her observations are: BP 173/80 mmHg, HR 83, RR 18, Sp02: 99% on air, T36 C. Strong pedal pulses are present bilaterally with CRT < 2 sec. Her skin over the affected calf is intact with normal temperature and no signs of cellulitis but is firm to palpate and is extremely tender on superficial touch.
The pain is exacerbated on passive stretch of the lower limb. Sensation in the lower limb is normal.
The calcaneal tendon is difficult to fully assess due to pain but appears intact. Hip and knee examination is unremarkable.
11 responses
Brilliant case for review
very insightful thank you
Brilliant case review
Pain out of proportion is often a tell-tale sign. I had a similar case in a 90 year old (who was not taking anticoagulant as in this case) and it turned out to be an acute ischemic limb due to an emboly.
Topic very refreshing. Provocative learning !!
Never seen such a case, but this sparks a thought ignition when ever we come across from now on
Good revision module
This article will be very useful
good presentation
Brilliant learning!!
Good learning points for an uncommon diagnosis