Updated 31 August 2015

Answer: What's your diagnosis? – Case 24

Mrs L, an air hostess, has a painful, swollen leg. Based on clinical history and examination, she most likely suffers from a deep vein thrombosis.


Sudden onset swelling and pain in limbs should always be attended to by a doctor. A number of  things can cause swelling, including insect bites, bruises, muscle injury and, most concerning, a deep vein thrombosis (DVT). DVT is the medical term for when a blood clot forms in the venous blood vessels of the limbs. This condition can be potentially fatal and always requires medical attention.


Blood clots can form anywhere in the body, but are more commonly found in the blood vessels of the lower limbs and pelvis. The legs have two venous "systems", i.e. deep veins and superficial veins. When blood clots form in the deep veins, they can potentially dislodged fully or partially and end up in the lung where the can cause pulmonary embolism and death.

Read: DVT a danger during travel

A number of factors can cause a DVT. These include immobility for prolonged periods of time, surgeries (like hip replacements, which will also immobilise the patient), pregnancy, varicose veins, cancers and paralysis. Other factors increasing the risk for developing DVT's include: smoking, long haul flights and the use of birth control methods like oral contraceptive pills.

Symptoms and signs

Sudden onset pain, swelling, tenderness or discomfort in a limb are usually among the first symptoms. Swelling of the limb is usually unilateral (one side only). Redness and a marked temperature difference between the two limbs are important signs. The pain is usually intense and the patient can often not carry weight on the affected leg.

Read: Pain Centre

In the case of possible pulmonary embolism, sudden shortness of breath, chest pain and severe lightheadedness should be looked out for.


When clinical suspicion arises that a DVT might be the cause of the symptoms and signs, a doctor will do blood tests like D-Dimer to check for possible clotting problems in your blood. Ultrasound of the veins of your legs and MRI's will also be performed.


DVTs are treated with blood thinners (like warfarin, xeralto or pradaxa). These will prevent the clot from growing or new clots from developing.

Occasionally surgery is needed where the clot might be removed, or a filter is placed in the vena cava to prevent small pieces of clot that might break-off travelling to the lungs.

Mrs L had a couple of risk factors for development of DVT's: she is smoker, she works as an air hostess causing her to sit for long periods of time, and she also uses a birth control pill. Based on the supplied information, it is unlikely the clot has as yet caused any other problems.

NOTE: Health24's on-site GP Dr Owen Wiese reveals new cases on Thursdays. The answer is posted with the story on Mondays, or you can get it in our Daily Tip – sign up here.

Previously on What's Your Diagnosis?

What's your diagnosis? -  Case 1: vomiting and weight loss

What's your diagnosis? -  Case 2: eye pain

What's your diagnosis? -  Case 3: strange behaviour and a bullet in the back

What's your diagnosis? -  Case 4: seeing odd things

What's your diagnosis? - Case 5: mysterious lungs

What's your diagnosis? - Case 6: runner with seizures

What's your diagnosis? - Case 7: swollen knee

What's your diagnosis? - Case 8: bloody semen

What's your diagnosis? - Case 9: confusing neurological signs

What's your diagnosis? - Case 10: diabetic teenager with unusual signs and symptoms

What's your diagnosis? - Case 11: bruising with no apparent reason

What's your diagnosis? - Case 12: severe tummy pain

What's your diagnosis? - Case 13: severe sore throat

What's your diagnosis? - Case 14: abdominal pain and swelling

What's your diagnosis? - Case 15: the world is spinning

What's your diagnosis? - Case 16: numbness in forearm

What's your diagnosis? - Case 17: burning urine

What's your diagnosis? - Case 18: boy with persistent fever

What's your diagnosis? – Case 19: lady who can't lose weight

What's your diagnosis? – Case 20: chest pain next to breastbone

What's your diagnosis? – Case 21: burning sensation in vagina

What's your diagnosis? – Case 22: vomiting and headaches

What's your diagnosis? – Case 23: frequent urination

Image: Painful lower leg from Shutterstock

Dr. Owen J. Wiese is Health24's resident doctor. After graduating from Stellenbosch University with additional qualifications in biochemistry and physiology he developed a keen interest in providing medical information through the media.


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