Leg Pain in a 62-yr-old Man

• General appearance: Middle-aged male in no apparent distress.


• Vital signs:
• Temperature: 38.5° C
• Pulse: 118 beats/min
• BP: 128/74 mmHg


• Skin: Diffusely flushed and diaphoretic. No rash or lesions, except for a 15 x 10 cm area of erythema on the lateral aspect of the right calf; the area is warm, indurated, and mildly tender. No bullae, crepitus, or fluctuance. No visible wounds, skin breaks, or abrasions. No athlete’s foot. Has a healed scar on the right leg running from ankle to mid-thigh from saphenous vein harvesting.


• HEENT: Unremarkable


• Neck: Normal carotid upstrokes. Jugular venous distention 12 cm above sternal notch at 45°.


• Pulmonary: Normal breath sounds bilaterally without crackles, rhonchi, or rubs.


• Cardiovascular: Tachycardia at 120 beats/min. No gallops, murmurs, or rubs. Pulses 2+ and symmetric bilaterally. No bruits.


• Gastrointestinal: Unremarkable


• Genitourinary: Unremarkable


• Musculoskeletal: In right leg shows 1+ pitting edema over the shin; right calf diameter is 2-cm greater than that of the left. No calf tenderness to compression although the erythematous area noted on the skin exam is mildly tender. No visibly or palpably distended veins. No clubbing or splinter hemorrhages. Left leg appears normal.


• Neurologic: Unremarkable


• Mental status: Alert, oriented to person, place, and time.