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Case 162: Post op leg pain

1. What is the diagnosis?

Superficial Thrombophebitis, in the territory of the long saphenous vein.

2. How would you manage this problem?

1. Confirm the diagnosis
2. Exclude extension to the deep system
3. Exclude associated deep vein thrombosis
4. Exclude any underlying predisposition
5. Symptomatic care - leg elevation, analgesia, antiinflammatories, DVT prophylaxis
6. Observation for skin breakdown and superimposed cellulitis.

Basically a duplex ultrasound of the lower limb is required. It will confirm the diagnosis, judge whether the clot extends up to or through the sapheno-femoral junction, and screen for deep system thrombus.

Underlying predisposition includes all usual causes of DVT. Of special interest is the association with intraabdominal malignancy especially pancreatic cancer. - Trousseau's sign of migratory thrombophlebitis.

Dr. Armand Trousseau first described this finding in himself; he was subsequently found to have pancreatic cancer.
Trousseau's sign of malignancy