RT Book, Section
A1 Bittenbender, Peter M.
A1 Dean, Steven M.
A2 Dean, Steven M.
A2 Satiani, Bhagwan
A2 Abraham, William T.
SR Print(0)
ID 1105292115
T1 PHLEBOLYMPHEDEMA
T2 Color Atlas and Synopsis of Vascular Diseases
YR 2015
FD 2015
PB McGraw-Hill Medical
PP New York, NY
SN 9780071749541
LK accesscardiology.mhmedical.com/content.aspx?aid=1105292115
RD 2024/04/20
AB A  58-year-old  morbidly  obese  woman  presents  for  a  second  opinion  regarding  leg  swelling.  She  describes  bilateral  lower  extremity  swelling  and  discoloration  that  has  progressed  over  the  past  4  years.  Examination  is  remarkable  for  a  body  mass  index  (BMI)  of  47  and  severe  nonpitting  bilateral  leg  swelling  involving  the  dorsal  feet  and  toes  with  extension  to  the  distal  thighs.  Atrophy  is  identified  within  hyperpigmented  distal  calves,  which  are  diffusely  indurated  (Figure  72-1).  Verrucous-appearing  papules  with  deep  creases  overlie  the  distal  calves.  Although  venous  duplex  ultrasonography  does  not  indicate  deep  venous  thrombosis  (DVT),  incompetent  deep  and  superficial  veins  are  identified  bilaterally.  The  patient  is  ultimately  diagnosed  with  a  combination  of  chronic  venous  insufficiency  (CVI)  and  lymphedema  or  phlebolymphedema.