Question

A 65-year-old male, presented with acute onset pain in right lower limb, with absent popliteal and below pulses. On admission, patient had ongoing pain and was having venous signals in foot with mild to moderate sensorimotor deficit.
What is your diagnosis? Classify the different types of presentation.

Hint:

Acute limb ischemia is a medical emergency. Immediate intervention is required to restore blood flow and prevent irreversible tissue damage.

Answer 1

Step 1: Understanding the clinical signs.
The patient presents with acute onset pain, absent pulses in the right lower limb, and a sensorimotor deficit. The absence of pulses suggests arterial insufficiency, and the venous signals in the foot may indicate venous congestion or inadequate perfusion. These findings are suggestive of acute limb ischemia (ALI), a condition where there is a sudden decrease in limb blood flow, typically due to a blockage in an artery.

Step 2: Diagnosis - Acute Limb Ischemia (ALI).
ALI is characterized by the sudden onset of pain, absent pulses, and motor/sensory deficits. It is a vascular emergency, often caused by embolism, thrombosis, or trauma leading to ischemia. The diagnosis is supported by the absence of arterial pulses and neurological deficits, but the presence of venous signals suggests some residual venous return.

Step 3: Classification of presentation.
The presentation of ALI can be classified into the following types:
1. Embolic: Occurs when a clot (often from the heart) travels to a distal artery, blocking blood flow. It typically affects a previously healthy vessel.
2. Thrombotic: Caused by the gradual accumulation of a blood clot (thrombus) due to underlying atherosclerosis. Symptoms develop more slowly but can still lead to acute ischemia.
3. Traumatic: Resulting from external injury causing arterial rupture or blockage. This is often seen in cases of trauma or surgery.
4. Hypercoagulable states: Conditions that increase clotting risk, such as cancer or clotting disorders, may lead to ALI.

Step 4: Conclusion.
The most likely diagnosis in this patient is acute limb ischemia, potentially embolic or thrombotic in origin. Further evaluation is necessary to determine the cause of ischemia.