A Not So Simple Case Of Chronic Leg Pain

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A Not So Simple Case Of Chronic Leg Pain - Page #3

Lab Studies: Thyroid stimulating hormone, hemoglobin A1c, complete blood count, and a complete metabolic panel were obtained during a recent annual exam at an outside clinic. All tests were within normal limits. Other Studies: Lower extremity exertional ankle-brachial indices showed right leg resting of 1.03, post-exercise 0.88. Left leg resting ankle-brachial index was 1.07, post-exercise 0.88. Magnetic resonance angiography of the lower extremities Case Photo #1 revealed mild diffuse narrowing of bilateral distal femoral, popliteal, and tibioperoneal arteries in plantarflexion, and 50% stenosis of left popliteal artery with plantarflexion. The image on the left is in plantarflexion and the right is in dorsiflexion. Consultations: Vascular surgery was consulted, given the imaging findings. The patient underwent bilateral lower extremity angiograms which revealed significantly reduced flow through bilateral popliteal arteries during active dorsiflexion and normal flow in neutral positioning. Oddly, the angiograms showed reduced flow during active dorsiflexion, however, the magnetic resonance angiography demonstrated reduced flow during active plantarflexion. Click here to continue. Challenge yourself by writing down a revised, working diagnosis before moving to the next slide.		Back
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