Education And Debate

Lesson of the Week: Paradoxical embolism in a young woman

BMJ 1996; 312 doi: (Published 25 May 1996) Cite this as: BMJ 1996;312:1350
  1. A T Edwards, senior registrarad,
  2. S Vig, senior house officera,
  3. M A Denvir, senior registrarb,
  4. A Wood, consultantc,
  5. A Wood, consultant
  1. a Department of Surgery, University Hospital of Wales, Cardiff CF4 4XW
  2. b Department of Cardiology, University Hospital of Wales
  3. c Department of Radiology, University Hospital of Wales
  1. dCorrespondence to: Mr
  • Accepted 9 January 1996

Acute arterial ischaemia of the lower limb is common and mainly affects elderly people. It is usually due to thrombosis or embolism from a source in the left side of the heart. We describe the case of a young woman who presented with evidence of acute arterial embolism and venous thrombosis. This highlights a diagnosis that should be considered in all patients with an unusual presentation of leg ischaemia.

Case report

After an alcoholic binge a 31 year old woman fell asleep in an uncomfortable position curled up on a sofa. She woke the next morning with blue swollen feet that were tingling. She ignored this, but over the next seven days her condition deteriorated and her feet became more painful and blistered. When admitted to the local hospital, she was dishevelled and dehydrated with a fever of 39.5°C. Her heart rate on admission was 70 beats/min in sinus rhythm, and she was hypotensive at 90/60 mm Hg. There were no heart murmurs. Her foot pulses were impalpable, which was thought to be due to oedema; her pulse status was not investigated further at this stage. She was thought to have bilateral leg cellulitis and was treated with intravenous antibiotics. When her right leg failed to improve after three days she was reviewed by the local surgeons, …

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