Swollen Calf Flashcards
What are the main factors to consider when coming up with a differential diagnosis for calf swelling?
Is it acute or chronic?
Is it in one leg or both legs?
Construct a differential diagnosis for a single acutely swollen calf.
DVT Cellulitis Ruptured Baker’s cyst Muscle strain Septic arthritis Allergic response (e.g. to an insect bite) Compartment syndrome
Construct a differential diagnosis for bilateral calf swelling.
Right heart failure Lymphoedema Venous insufficiency Pregnancy Vasodilators (e.g. CCBs) Hypoalbuminaemia Pelvic tumour
List some key features of the history that you should ask the patient about.
Symptoms of PE
Cuts/wounds/insect bites on affected limb
Is the swelling getting any bigger?
Signs of pelvic malignancy (e.g. PR bleeding, unusual vaginal bleeding, abdominal pain)
Radiotherapy and surgery to affected leg
List some risk factors for DVT.
Trauma Surgery Bed rest Long-haul travel Cancer Pregnancy OCP and HRT
List the main symptoms of PE.
Breathlessness
Pleuritic chest pain
Haemoptysis
Which cause of calf swelling is associated with a rapidly growing swelling along the affected limb?
Cellulitis
Why should you ask about symptoms of GI, ovarian and uterine malignancy (e.g. PR bleeding, unusual vaginal bleeding, weight loss)?
A pelvic mass (e.g. a tumour) could compress the iliac veins or IVC leading to leg swelling
Why should you ask a patient about previous radiotherapy and surgery to the affected leg?
Increases risk of lymphedema
List how, on examination, the nature of the swelling is different in:
Septic Arthritis
Compartment Syndrome
Baker’s Cyst
- Septic Arthritis
Swelling around the joint - Compartment Syndrome
Swelling/inflammation is confined to the compartment but spares the joints - Baker’s Cyst
Swelling protrudes backwards from the knee joint into the popliteal fossa
NOTE: rupture of the Baker’s cyst can make the swelling run down into the calf
Why is it important to palpate for abdominal masses?
Abdominal masses could compress the IVC or iliac veins leading to leg swelling
Why is it important to assess the neurovascular status of the affected limb?
The high pressure within the compartment in compartment syndrome can lead to compromise of neurovascular status
Describe how the pain on passive movement is different in:
Septic Arthritis
Compartment Syndrome
- Septic Arthritis
Pain in the joint - Compartment Syndrome
Pain in the calf
Describe how the Wells’ score is interpreted.
< 4 = D-dimer to rule out PE
4+ = CTPA
What the most sensitive, rapid and non-invasive method of visualising a DVT?
Doppler ultrasound of proximal leg veins
NOTE: this can also help distinguish DVTs from Baker’s cysts