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 2024/10/14 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.