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Case 175: Fat leg

1.Using the information from the photo, can you suggest a possible cause for his shortness of breath?

A right leg deep vein thrombosis and subsequent pulmonary embolism.

In fact this man on further inspection, can be seen to have swelling of the entire right thigh as well, indicating clinically, that the thrombosis extends well above the knee. On lower limb duplex ultrasonography there was a thrombosis extending proximally to the common iliac vein. This was not well captured in the photo, but clinically the patient had a Phlegmasia Cerulea Dolens.

Phlegmasia Alba and Cerulea Dolens - emedicine.com

Case contributor
Michael Hong, Medical student, Melbourne University, Melbourne, Australia.