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Reprint Address: Pin-Han Wang, md, Department of Emergency Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100 Shichuan 1st Road, Kaohsiung 80708, Taiwan
Affiliations
Department of Emergency Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
A 60-year-old man presented to the emergency department with pain and swelling of
the left lower limb, which deteriorated rapidly in 1 day. On physical examination,
his left lower limb was cold, violaceous, swollen, and tender (Figure 1). In addition, no pulse was palpable in his left dorsalis pedis. He did not have
a history of cancer, immobilization, recent surgery, trauma, or coagulation dysfunction.
Contrast-enhanced computed tomography revealed a venous thrombus extending from the
left common iliac vein to the popliteal vein. Anticoagulation with heparin was prescribed.
However, the rapid deterioration of the symptoms suggested acute compartment syndrome,
so emergency fasciotomy was performed. After the operation, hemodynamic instability
was still observed. Bedside echocardiography revealed left ventricular dysfunction
with global hypokinesia (left ventricular ejection fraction 24%) and right ventricular
strain. Pulmonary embolism was highly suspected. The patient died the next day.
Figure 1Patient's left lower limb presented with severe pain, edema, and violaceous.
