A Trip You Won’t Forget

Bradley is a 47 y/o male that presented to our office 3 weeks ago with a complaint of swelling to his right lower extremity and muscle soreness for one week.  Brad related that 2 weeks prior he underwent a minor surgical procedure and following that took a road-trip to a theme park where he and his family enjoyed a couple of days of fun and relaxation.  He related that shortly after that trip he started to notice redness and swelling in the back of his calf.  The redness resolved but the swelling and soreness have persisted.  Brad is an active healthy individual.  He works out regularly, does not take any medications, and has never experienced anything like this in his past.  He thinks he has some tendonitis from walking at the theme park and “getting older.”

Upon examination, there is a significant amount of swelling on his right side and tenderness when squeezing the back of his calf.  When I push his ankle back, he also has pain in his calf.  Based off of his history one of my differential diagnosis is a Deep Vein Thrombosis or a blood clot in his leg.  It seems unlikely but worth investigating, as a blood clot can break off and go to the lung, possibly resulting in death.  I sent Brad to the hospital for a Venous Duplex Ultrasound, the gold-standard in diagnosing a blood clot in the leg.  Sure enough he had a large clot from his ankle up to his knee.  He was started on anti-coagulant medication and is responding well.

As I have taught many young surgeons and physicians, you have to have a high index of suspicion for blood clots.  Their presentation is not always typical and many times in my practice we have had patients’ positive for a blood clot that we are just checking to be thorough.  Risk factors of blood clot include prior history of blood clot, family history of blood clot, females, and age over 40, overweight/obesity, period of immobilization, air travel, etc.  If you suspect you might have a blood clot, do not wait.  Have it investigated immediately as it might be a matter of life and death.

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