28. Swollen Calf

Question 1

What are differential diagnoses for an acutely swollen calf?

Answer 1

Deep vein thrombosis, cellulitis, ruptured baker’s cyst, muscular strainuncommon: septic arthritis, allergic response, compartment syndrome

Question 2

What are differential diagnoses of bilateral swollen legs?

Answer 2

Right heart failure, lymphoedema, venous insufficiency, pregnancy, vasodilators

Question 3

What specific questions should you ask about an acutely swollen calf?

Answer 3

Hypercoagulable blood Qs, stasis, vessel injury
Breathlessness, chest pain, coughing up blood
Cuts, insect bites, other wounds (cellulitis, septic arthritis)
Any abdo pain, blood in faeces, unusual vaginal bleeding, weight loss, fever, malaise (pelvic malignancy)
Radiotherapy or surgery (damaged lymohatic drainage)
Does pain occur on movement? (septic arthritis)

Question 4

Swollen calf- what would you look for on examination?

Answer 4

cuts, bites, superficial infections

location of swelling- arthritis will be over joint, compartment syndrome comfined to certain compartment, ruptured synovial sac (baker’s cyst) would emerge from popliteal fossa and track down into calf

extent of swelling- measure with tape

Lymohadenopathy- suggests infection

abdo masses- mass in right lower quadrant would suggest tumour compressing right iliac vein

Question 5

How would you diagnose DVT?

Answer 5

Wells score, D dimer and ultrasound scan, also do FBC

Question 6

How would you manage DVT?

Answer 6

Anticoagulation- LMWH, compression stockings and lifestyle advice