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Updated 17 September 2015

What's your diagnosis? – Case 27: sudden severe leg pain

Mr D is a 67-year-old retired mine worker suffering from severe pain in his right leg. Based on his history and examination, see if you can figure out the cause of Mr D's problem.

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Mr D, a 67-year-old retired mine worker, presents to his doctor with a sudden onset painful lower right leg. The pain started overnight and woke him up at 4 o'clock in the morning. Ever since he has not able to sleep as the pain is progressively becoming worse. Nothing he does brings any relief from the pain. 

He also has diabetes which seems to be poorly controlled as his sugar is constantly above 12, despite the use of insulin and oral medication. He does take his blood pressure medication regularly.

Mr D is also a smoker and uses alcohol regularly.

The following is a summary of his doctor's clinical notes:

History

Sudden onset right leg pain; progressively worsening; patient not able to carry weight on leg; reports experiencing pins and needles in foot; foot feels cold according to patient.

No recent injury to leg.

On examination

Swollen, very tender right leg

Clear temperature difference between right and left legs

Difficult to detect pulse in right leg

Skin: blueish-mottled appearance

Cardiac and respiratory exam: no severe abnormalities noted

Side room

Blood pressure: 198/88

Pulse: 110

Temperature: 38,6

Mr D's doctor urgently refers him to a surgeon. Why is this? Use the above information to figure out the diagnosis in this week's mystery case.

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

 
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