Swollen Calf

Question 1

What are differential diagnoses for an acutely swollen calf?

Answer 1

Deep vein thrombosis, cellulitis, ruptured baker’s cyst, muscular strain

uncommon: 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 bits, other wounds (cellulitis, septic arthritis)

Any abod 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

cute, bites, superficial infections

location of swelling- arthritis will be over joint, compartment sundrome comfined to certain cimpartment, 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

neurovascular status of limb

pain on gentle passive movement

is patient febrile

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