Case 300 Medical history A 53-year-old male patient, previously healthy, sought urgent care complaining of severe and sudden pain in the left lower limb a few hours ago. On examination, paresthesia, edema, cyanosis and absence of distal pulses in the painful limb. Arterial and venous duplex scan of the left lower limb were performed, which confirmed the initially suspected hypothesis threatening the lower limb viability. Photograph of the patient's lower limbs in the ventral decubitus position.Duplex scan of the left common femoral vein, longitudinal section.Duplex scan of the popliteal vessels of the left lower limb, transverse section. Question:According with the clinical case, the images available and the most probable diagnosis, what is the best immediate management for this patient? Heparinization and catheter-directed fibrinolysis Heparinization and systemic fibrinolysis Anticoagulation with vitamin K antagonist Full anticoagulation with unfractionated or low molecular weight heparin Test Question (Medical Residency 2014 - Unified Selection for Medical Residency of the State of Ceará) A 60-year-old male patient, late postoperative of left femoral neck fracture, presented to an emergency department with intense pain in the contralateral leg. On examination, it presents diffuse hypersensitivity in the affected lower limb and depressible edema in the whole leg, more intense in the region of the calf, which is 5 cm larger than the left leg. Question:There is no erythema. What is the most appropriate test to confirm the most probable diagnostic hypothesis in this case? Venography Dosing of d-dimer Venous angiotomography Doppler ultrasonography Time is Up! Time's up
