Deep Vein Thrombosis vs. Cellulitis

Today I saw a 68 year old male, with history of Diabetes and Hypertension who was complaining of right calf edema, pain and erythema since he woke up this morning. He refers he “thinks he got bitten by something”.

The picture here is not from the patient himself.

                                                     This is what his varicose veins look like.

Around the center area of the calf there is a round spot, about 3.5” in diameter, which was erythematous and tender. This was present only on one leg.

The patient denies fever or recent trauma. He had a positive

Homans sign

* Discomfort in the calf muscles on forced dorsiflexion of the foot with the knee straight has been a time-honored sign of DVT. However, Homans sign is neither sensitive nor specific: it is present in less than one third of patients with confirmed DVT, and is found in more than 50% of patients without DVT.

The patient had to be sent to the ER for a possible Deep Vein Thrombosis. Also, it could be a Cellulitis. The patient’s history of varicosities suggest circulatory problems, so correlating one with the other I though it more prudent to have him get an ultrasound to discard or diagnose Deep Vein Thrombosis at the ER. I should get the results in the next few days.