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Forum Name: Hematology Topics

Question: deep vein thrombosis


 parrotflower - Sat Jul 24, 2010 5:01 pm

Hello! I had knee sugery done last week to fix a torn miniscus. About 4 days ago, I developed severe pain in the calf of my left leg, where my surgery was done. I thought it might be muscle related,so I asked my fiance to rub it. He said he could feel a lump deep inside in the spot he was rubbing and that's the area that's very painful. This morning as I was putting lotion on my legs, the apinful area felt warmer than the rest of my leg, only it seemed to cool down with rest and gets warm when I'm upwalking around. Could this be a blood clot? Do they do that-get warm with walking and cool down with rest? I'm worried, as my mom was hospitalized in May of this year for blood clots on the lungs. She has had problems off and on with blood clots since she was in her 20's, but was never put on blood thinners until her incident in May. Could this also be something hereditary? Thank you for your time!
 Dr.M.Aroon kamath - Mon Jul 26, 2010 11:12 pm

User avatar Hi,
Your concern about DVT is well founded. A past history of varicose veins, a family history of pulmonary embolism, either proven or suspected, and the history of recent lower extremity surgery, certainly would be reasons enough to cast aspersions.

Of course a DVT needs to be excluded soon as well as, congenital thromophilias.

However, there are other conditions that also may cause a similar clinical picture such as,
- Cellulitis,
- Baker's cyst,
- Torn gastrocnemius muscle,
- intramuscular haematoma s
etc.

Clinical diagnosis alone of venous thromboembolism is often inaccurate, and most patients with suspected venous thromboembolism do not have the disease.

As you had recently undergone a knee arthroscopy, one other condition (although appears very unlikely in your case) at the least, merits discussion and that is, extravasation of irrigation fluid.

Extravasation of irrigation fluid is the unintended migration of irrigation fluid used as part of a surgical procedure or certain other procedures in clinical practice.This may be realized during a procedure or in the post operative period.It can result in a compartment syndrome. There have been case reports of delayed presentations(up to a week following discharge from hospital).

In the context of knee arthroscopy (and other arthroscopic procedures), this may occur into the calf muscles,thigh muscles or other neighboring muscles.

Hypotheses: Capsular defects may aggravate risk. In individuals with intact knee joint capsules, fluid may dissect around the semimembranosus bursa or beneath the tendons of the sartorius, gracilis, and semitendinosus muscles and thus find entry into the calf muscles.

The use of pressurized pulsatile irrigation systems, automated arthroscopy pumps for the infusion of fluids into the joint during an arthroscopic procedures,and the use of pressurized intravenous infusion of parenteral fluids have contribute to genesis of this complication.The use of a pneumatic tourniquets adds to the risk.

You must consult your orthopedic surgeon immediately and get assessed.Generally, investigations such as compression ultrasonography and color fow duplex imaging are often the preferred initial investigations.

In the event DVT is ruled out in your case following these and other tests, a hematoma within the calf muscles seems most likely (perhaps causing local inflammation or in the process of getting infected).
Good luck!

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