RT Book, Section
A1 Stanbro, Marcus D.
A1 Chastain, Stephen L.
A2 Dean, Steven M.
A2 Satiani, Bhagwan
A2 Abraham, William T.
SR Print(0)
ID 1105291931
T1 LEG SWELLING SECONDARY TO MUSCLE RUPTURE
T2 Color Atlas and Synopsis of Vascular Diseases
YR 2015
FD 2015
PB McGraw-Hill Medical
PP New York, NY
SN 9780071749541
LK accesssurgery.mhmedical.com/content.aspx?aid=1105291931
RD 2024/04/20
AB A  67-year-old  man  presented  with  spontaneous  left-calf  pain  and  swelling  of  2-days  duration.  Four  weeks  prior,  he  had  undergone  percutaneous  angioplasty  of  the  left  anterior  descending  artery  (LADA),  and  was  discharged  on  aspirin,  warfarin,  and  clopidogrel.  On  examination,  the  left  calf  was  swollen  and  tender  with  subtle  erythematous  changes.  Posterior  tibial  and  dorsalis  pedis  pulses  were  palpable.  There  were  no  ecchymoses  or  petechiae  noted.  A  venous  duplex  showed  a  large,  complex,  mostly  hypoechoic  fluid  collection  beginning  at  the  proximal  posteromedial  aspect  of  the  calf,  with  distal  extension  to  the  medial  mid  calf  (Figures  68-1  and  68-2).  The  collection  was  below  the  muscular  fascia  and  consistent  with  an  intramuscular  hematoma.  Due  to  progressive  swelling  and  pain,  he  was  taken  to  the  operating  room  where  a  moderate  amount  of  coagulum  was  removed  from  the  gastrocnemius  muscle.  Although  acute  deep  vein  thrombosis  (DVT)  should  be  the  predominant  concern  when  anyone  presents  with  acute  unilateral  pain  and  swelling,  this  was  unlikely  in  this  patient  since  he  was  therapeutically  anticoagulated.