UOTW #77

46 yo f presents with LLE pain. On physical exam you note an area of redness on the lateral aspect of the thigh. Ultrasound demonstrates the following image. What is the appropriate management of the patient?


Answer

3 thoughts on “UOTW #77

  1. The Vessel is not compressible. DVT. Start low molecular heparin, infections parameters and d-dimer. If respiratory symptoms, the further diagnostics.

    1. Thrombus in the femoral vein . Likely DVT unless proven otherwise. To start enoxaparin 1.5mg/kg sc if there are no contraindications for anticoagulation and arrange a diagnostic Doppler to confirm the diagnosis and extent of the clot. If any respiratory symptoms then to consider PE and treat accordinlgy

  2. We see incompressible vessel filled with echogenic material. The vein is great saphenous vein , because is situated in the saphenous compartment between the superficial and deep fascia with so called ” egyptian eye ” configuration. So the diagnosis is superficial vein thrombohplebitis. With normal and not thrombosed deep veins the risk for PE is practically absent so no need to worry about that. Also evaluation of the valve competency in the SFj is advisible to better understand the patophysiology. The management will be supportive with compression stockings , i would give doxycicline also with some dressings, LMWH for about 14 days, and the reconsider about switching to OAT

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