Complaint A 28-year-old woman has a painful and swollen right leg. She says her symptoms began 2 days ago, as she was getting off a plane after a 13-hour flight from overseas. Her symptoms have increased gradually since that time. She denies left leg complaints, shortness of breath, or chest pain. History Past medical history is insignificant and the patient's only regular medication is oral contraceptive pills. The patient smokes 1 pack of cigarettes per day. Physical Exam The patient has a low-grade fever (101.3 °F [39 °C]). She is obese but in no acute distress. The right leg below the knee is edematous, enlarged, mildly erythematous, and warmer to the touch than the left leg. With the knee flexed, forceful dorsiflexion at the ankle causes severe calf pain. The rest of the physical exam is normal. Tests Hemoglobin: 13 mg/dL (normal 12-16) White blood cell count: 8400/μL (normal 4500-11,000) Platelets: 330,000/μL (normal 150,000-400,000) Creatinine: 0.9 mg/dL (normal 0.6-1.5) Sodium: 142 mEq/L (normal 135-145) D-Dimer: positive
Deep vein trombosis. Risk factors: oral contraceptives, smoking, immobility in-flight. Symptoms: painful swollen leg temporal relationship to flight, Signs: positive Homan sign (dangerous to do as it can dislodged the clot), warm and tender. Lab tests: + D-dimer. Pt needs Duplex doppler to confirm diagnosis. Anticoagulate immediately.
