Swollen right leg: is it deep vein thrombosis?

To cite: Lee W, Siau K. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/bcr-2013202066 DESCRIPTION A 72-year-old man, with known atrial fibrillation on anticoagulation, presents to the general practitioner with a 1-week history of a new tender, right swollen leg. The popliteal pulse was not palpable due to oedema. Distal pulses were present with no neurological deficit. The patient was referred to the accident and emergency department for deep vein thrombosis exclusion. Other more common differentials to consider were: ruptured Baker’s cyst, chronic venous leg insufficiency, infection, trauma, lymphoedema and malignancy. The ultrasound Doppler did not identify a deep vein thrombosis and the patient was discharged. A fortnight later, the patient was re-admitted with hypotension and a palpable pulsatile, fluid mass at the right popliteal fossa. Distal foot pulses were diminished and there was no neurological deficit. Repeat ultrasound Doppler revealed a large right popliteal artery aneurysm (figure 1). Urgent CT angiogram of the legs showed that this aneurysm had ruptured (figure 2). The patient did not survive this admission. Popliteal artery aneurysms are defined as having a diameter >0.7 cm. Prevalence is 1% in males, aged 65–80 years. It is caused by arteriosclerosis and is often associated with additional aneurysms elsewhere. Indications for surgical intervention include leg swelling, pain, aneurysm rupture and/or if the popliteal artery aneurysm is >2 cm. Complications include acute ischaemia secondary to thrombosis. This is an unusual