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?
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What's your diagnosis? – Case 23: frequent urination
What's your diagnosis? – Case 24: painful and swollen leg