A swollen, tender, warm, red calf can be indicative of several conditions, one of which is Deep Vein Thrombosis (DVT).
Other differentials could include include cellulitis, muscle injury, achilles tendon rupture, phlegmasia and varicose eczema. Examining a swollen leg is a common OSCE station.
- Introduce yourself
- Check you have the right patient
- Explain what you are going to do
- Gain consent
- Wash hands!
- Look around the bed for any mobility aids
- Look for signs of pregnancy
- Look for signs of any recent surgery or trauma
- Look for GTN spray (atherosclerotic disease – increase risk factor)
- Look for breathlessness – may be present if there is a secondary PE
Inspection of the legs
- Look for any obvious redness and swelling
- Look for varicose veins
- Look for missing digits
- Look for ulcers
- Check the temperature of the legs at 3 different places. Compare the legs each time
- Check pulses
- Check for pitting oedema
- Check for tenderness – squeeze the patient’s leg around the ankle. Tell them what you are going to do first! Ask them if there is any pain, and look at their face! Repeat with the other leg
- Measure the diameter of the leg with a tape measure! Choose a point on the calf, and measure the same point on each leg. Usually this is 10cm below the tibial tuberosity.
- If there is a difference between the legs of >3cm then this is significant for DVT
- Listen at the lung bases – if PE is present, then there may be reduced breath sounds at the lung bases
Thank the patient, and tell them they can now cover up
Mention any further investigations:
- Well’s score – if this is low, do a D-dimer
- Bloods – U +E’s, clotting, FBC
- Duplex scanning – USS + Doppler