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Varicose veins, or varicosities, are abnormally dilated and twisted superficial veins caused by venous valve incompetence. This condition commonly affects the lower extremities, especially the saphenous veins, due to the higher pressure from prolonged standing and walking. However, varicosities can also occur in other areas, such as the esophagus, vulva, spermatic cords, and anorectal region.Etiology and typesPrimary varicose veins, often idiopathic, are more common in women due to inherent...
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Man With Bilateral Leg Swelling.

Jake Toy1, Alexander Garrett1, Yiju Teresa Liu1

  • 1Harbor-UCLA Medical Center, Department of Emergency Medicine, Torrance, California.

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|November 26, 2019
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Summary
This summary is machine-generated.

A rare cause of leg swelling was diagnosed using point-of-care ultrasound (POCUS) in the emergency department. This imaging technique quickly identified a tumor thrombus from kidney cancer, aiding prompt patient management.

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Area of Science:

  • Nephrology
  • Vascular Surgery
  • Emergency Medicine

Background:

  • Lower extremity edema can stem from various causes, including venous obstruction.
  • Inferior vena cava (IVC) tumor thrombus is a rare but serious complication of renal cell carcinoma (RCC).
  • Timely diagnosis is crucial for effective management and improved patient outcomes.

Purpose of the Study:

  • To highlight the utility of point-of-care ultrasound (POCUS) in the rapid diagnosis of IVC tumor thrombus.
  • To present a case of bilateral lower extremity edema caused by an IVC tumor thrombus secondary to RCC.
  • To emphasize POCUS's role in guiding initial emergency department management.

Main Methods:

  • A 52-year-old male patient presented with bilateral lower extremity edema.
  • Physical examination revealed a left upper quadrant mass.
  • Emergency department point-of-care ultrasound (POCUS) was performed to evaluate the abdominal mass and edema.

Main Results:

  • POCUS identified a hyperechoic, heterogeneous structure within the inferior vena cava.
  • The structure was consistent with a tumor thrombus originating from a primary renal cell carcinoma.
  • The tumor thrombus was the likely cause of the patient's lower extremity edema.

Conclusions:

  • POCUS is a valuable tool for rapid bedside diagnosis of IVC tumor thrombus in the emergency setting.
  • This case underscores the importance of considering rare etiologies for lower extremity edema.
  • Early POCUS diagnosis facilitated appropriate initial management decisions for the patient.