Hiking With A Swollen Leg - Page #1

Author: Cara Hall, MD
Co Author #1: Kenzie Johnston
Co Author #2: Blake Bogges

Patient Presentation:
A 62 year old male presented with three weeks of right leg swelling following a hiking trip in Uganda. He had stopped to rest on a log two feet off the ground and hit his right lower lateral leg on a tree trunk below him. He continued to hike as the incident was not painful. When he returned to camp, he noted swelling in his calf. He did not have access to ice, medications, or compression. Once he returned to the USA he presented to an urgent care facility for evaluation of right calf swelling with associated 1/10 pain on the VAS. Plain films showed no fracture. He was instructed to use an ACE wrap and follow up with his PCP. On day of evaluation the patient continued to have painless swelling in his right calf that worsened throughout the day and improved at night.

No pertinent medical history except history of right ACL tear.

Physical Exam:
BP: 100/70 P: 72 RR: 12 T: 36.7C BMI: 24.26

Gen: Alert, oriented, in no acute distress, appears well

Neuro: motor and sensory function grossly intact; normal gait

Ext: There is an area of well demarcated swelling and soft, fluctuant fluid collection in the proximal 1/3 of the right lateral leg extending distally 10 cm. No erythema, warmth, overlying bruising or discharge. 2+ DP pulse. No knee effusion present. 5/5 strength with flexion and extension. No TTP, erythema, or warmth over posterior calf.

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