A Case of Left Lower Limb Pain and Swelling in an Adult Male Patient.

A 60-year-old man presented to the emergency department with pain and swelling of the left lower limb, which deteriorated rapidly in 1 day. On physical examination, his left lower limb was cold, violaceous, swollen, and tender (Figure 1). In addition, no pulse was palpable in his left dorsalis pedis. He did not have a history of cancer, immobilization, recent surgery, trauma, or coagulation dysfunction. Contrast-enhanced computed tomography revealed a venous thrombus extending from the left common iliac vein to the popliteal vein. Anticoagulation with heparin was prescribed. However, the rapid deterioration of the symptoms suggested acute compartment syndrome, so emergency fasciotomy was performed. After the operation, hemodynamic instability was still observed. Bedside echocardiography revealed left ventricular dysfunction with global hypokinesia (left ventricular ejection fraction 24%) and right ventricular strain. Pulmonary embolism was highly suspected. The patient died the next day.