Deep pain in thigh/calf compartment or whole leg

__ ----------~7r------__
Localizedto skin, soft tissues or veins SIGNS OF INFLAMMATION

14.1 INITIAL ASSESSMENT

Pain in legs radiating from the back Exacerbated by bending or particular movements

b.
Tender area of skin which is hyperaemic, warm and red

b.
Red and very tender superficial vein

Thin, red lender streak on the skin

I
I I I

May be localized

lymphadenopathy

May be paronychia

or peripheral

ulceration

Inguinal lymphadenopathy

History of local intravenous catheterization or inflammation of varicose veins

Patient often has high fever

CELLULITIS Antibiotics

....

LYMPHANGITIS Antibiotics

SUPERFICIAL

THROMBOPHLEBITIS

Multiple attacks with no local predisposing factors, often in different areas, may be associated with malignancy (especially pancreatic carcinoma) THROMBOPHLEBITIS MIGRANS

,
I

14. ACUTE NON~TRAUMATICLEG

14.2 DEEP PAIN IN THIGH/CALF COMPARTMENT

PAIN

Pain and 'numbness' in limb Paresis/paralysis Paraesthesiae or hypoaeslhesia

Pain and unifonn swelling No paresis or sensory loss

I
ON EXAMINATION Pale, pulseless, cold limb Mottled, dusky-coloured periphery with reduced sensa lion

ON EXAMINATION Warm, lense, tender limb Low-grade pyrexia

~
May be evidence of embolic source, e.g. alrial fibrillation. cardiac dysrhylhmias, aortic/mitral valve disease. aortic aneurysm, ischaemic No evidence of embolic source Generalized features of peripheral vascular disease, Increased risk if female, obese, taking the oral contraceptive pill, recent operation, childbirth History of previous venous History of chronic joint disease Absence of risk factors for venous thrombosis

heart disease, recenTyocardial inlarction

abnormal purs

and bruits

thromr
Suggesls:

SiS

Suggests:
ACUTE ARTERIAL EMBOUSM

ACUTE ARTERIAL' TIiROMBOSIS

DEEP VENOUS TIiROMBOSIS (diagnosis must be confirmed contrast venographyl flow ultrasonography) by

Level of occlusion defined clinically by level below which pulses cannot be felt Urgent intervention necessary Cool limb to reduce metabolic requirement Care to avoid pressure necrosis

RUPTUREO BAKER'S CYST (pulsion diverticulum from arthritic knee)

Pelvic/soleal (para femoral) veins . (also axillary veins) Anticoagulate with i.v. heparin, then warfarin

CATHETER EMBOLECTOMY Peroperative angiography to exclude chronic vascular disease and confirm patency of distal vessels postembolectomy

Urgenl FOGARTY

Urgent angiography to localize stenoisi and assess for reconstruction thrombolysis and anticoagulalion, radiological stenting or surgical bypass

~.