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Ancient history
  1. David V Feliciano
  1. Shock Trauma Center/Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
  1. Correspondence to Dr David V Feliciano, Shock Trauma Center/Department of Surgery, University of Maryland School of Medicine, Baltimore, MD 21201, USA; davidfelicianomd{at}gmail.com

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History

After a 48-year-old man noted the gradual onset of painless swelling of the entire left lower extremity over a period of several weeks, he went to the surgery outpatient clinic of a local trauma center. He stated that the significant swelling of the left lower extremity made it feel “heavy” and that he was having difficulty walking. He denied any recent prolonged history of immobility or trauma to the left lower extremity. In addition, he denied any history of deep venous thrombosis or surgery on the trunk or left lower extremity. On further questioning, he remembered that he had been a victim of a gunshot wound to the left groin in Mexico 26 years earlier. He was certain that he did not have surgery after this injury.

Examination

The patient was awake and alert with normal vital signs. A small circular scar, presumably from the old bullet wound, was noted in the left mid-groin 4 cm inferior to the inguinal ligament. The entire left lower extremity was edematous and slightly darker in color than the right lower extremity. There were normal pulses in the left common femoral artery and popliteal artery, whereas the left dorsalis pedis and posterior tibial pulses were present but difficult to palpate because of edema. There was no palpable thrill nor audible bruit in the left groin. Sensory and motor functions of the left lower extremity were normal.

Question

Based on the history and physical examination, the most likely diagnosis is:

  1. Pseudoaneurysm of the left common femoral vein.

  2. Thrombosis of the left femoral vein.

  3. Congenital lymphedema (Milroy’s disease).

  4. Traumatic femoral arteriovenous fistula.

Diagnosis

The patient was thought to have …

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