Ultrasound Case of the Week #16
Thanks to Terry Moslander in preparation of this case...
Chief Complaint: “ My legs are swollen and they hurt”
HPI: Pt. is a 33 year old Caucasian male who presents to the ED with 5 days of bilateral lower leg swelling and pain. Pt. was recently discharged from the hospital and diagnosed with a left septic sacroiliitis from Methicillin-sensitive Staph Aureus. Pt. reports swelling started in his feet several days ago and slowly has moved up his bilateral calves. His feet are "swollen about 3 times their normal size" and the swelling "doesn’t go down at night." He states his legs are warmer than the rest of his body. Pt. reports that since being home he is mostly bed ridden. Ambulation is decreased. It "hurts to walk."
ROS: Positive for nonpitting edema, N/V. Negative for fevers, chills, SOB, CP, cough, weakness, numbness, diarrhea. No history of DVT, PE or blood dyscrasia.
PMH: Hx. of pneumonia and UTI’s
PSHX: Cholecystectomy
Meds: Morphine, Flexeril, Phenergan, Rifampin, Levaquin
SHX: Married, denies tobacco, etoh, illicits,
PE:
Vital signs: Temp 98.4, pulse 101, respirations 20, BP 115/76, O2 sat 100%
General: NAD, overweight
Heent: NCAT, PERRL, EOMI, Mucous membranes moist
CV: RRR no murmurs, rubs, gallops
Lungs: CTA bilaterally
Abd: soft, NTND, + bowel signs
MS: FROM, bilateral pitting edema in feet with some swelling in bilateral calves, erythema bilaterally, but no point tenderness. No ulcers present, no cords palpated.
Neurologic: A&O x3, cranial nerves 2-12 grossly intact, sensations equal bilaterally, strength equal bilaterally
Workup: BMP and CBC unremarkable
LFT's and albumin normal
UA without proteinuria/hematuria/casts
To the US!
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