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Updated 22 September 2015

Answer: What's your diagnosis? – Case 27

Mr D is suffering from sudden onset pain in his right leg. Based on his history and lifestyle, he most likely suffered acute limb ischaemia – a surgical emergency.

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Acute limb ischaemia (ALI) is a surgical emergency where the blood flow to a limb is disrupted and no oxygen rich blood can reach the tissues of the limb.

The cause of disrupted blood flow is usually thrombosis (where atherosclerosis of blood vessels leads to blockage of a blood vessel) or due to embolism (where a blood clot blocks a blood vessel). In most cases ALI is caused by atherosclerosis (85% of cases) with risk factors that include:

1. Diabetes

2. Smoking

3. Heart conditions like arrhythmias, heart attacks

4. High cholesterol

Other factors that might enhance the risk of ALI includes cancers, blood clotting disease, previous intravenous drug abuse and hypertension.

Usually patients with established blood vessel disease report pain with walking (claudication). This is a very important clue and doctors should always ask about pain with movement and also the presence of pain when not walking.

Read: Claudication

Patients will typically present to their doctor with significant pain, a cold limb and the inability to walk due to pain. The patient will also report that the limb may differ in colour from the other limb.

The doctor will check for the following which is indicative of ALI:

1. Swelling

2. Temperature difference (cold limb)

3. Pain

4. Weakness

5. Loss of sensation

6. The absence of pulses

If any or some of the above signs are present, urgent referral to a specialist vascular surgeon is needed. The vascular surgeon will evaluate the limb, do special investigations like checking blood flow to and from the limb and prepare the patient for surgery if needed.

It is important to determine where the occlusion is located in order to restore blood flow to the limb. CT angiography is a method doctors use to check where the blockage might be located an also plan surgery.

Surgery aims to restore blood flow. This can either be done by removing the occlusion or by bypassing the occlusion and restoring blood flow. In patients unsuitable for surgery, medication may be given to break up the occlusion.

Read: Dark chocolate may improve blood flow to the legs

Treating ALI as early and quick as possible is important as delay in treatment and diagnosis worsens the prognosis for the patient. If left untreated, amputation of the limb or even death of the patient may follow. Outcome is determined by the size of the occlusion, the location of the occlusion, the duration of the symptoms, the risk factors of the patient and the suitability for intervention.

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

What's your diagnosis? – Case 24: painful and swollen leg

What's your diagnosis? – Case 25: swollen knee and fever

What's your diagnosis? – Case 26: swelling of face

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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