Rationale

Localized expansion of interstitial fluid volume can be caused by serious diseases and is a common cause of patient concern.

Causal Conditions

(list not exhaustive)

1. Venous insufficiency (e.g., post-thrombotic syndrome)

2. Deep vein thrombosis

3. Trauma

4. Lymphedema (e.g., malignancy, primary)

5. Infection (e.g., cellulitis, soft tissue, bone)

6. Inflammation (e.g., ruptured Baker cyst, chronic dermatitis)

Key Objectives

Given a patient with localized edema, the candidate will diagnose the cause, severity, and complications, and will initiate an appropriate management plan. In particular, diagnosis of proximal deep vein thrombosis must be considered.

Enabling Objectives

Given a patient with localized edema, the candidate will

1. list and interpret critical clinical findings, including those based on

   1. elicitation of a history of risk factors for deep vein thrombosis,

   2. examination of the extremity for signs associated with specific causes (e.g., palpable clot, tenderness), and

   3. in the case of suspected deep vein thrombosis, classification of the patient into a pretest probability category (e.g., Wells criteria);

2. list and interpret critical investigations (e.g., D-dimer assay, duplex ultrasonography);

3. construct an effective initial management plan, including

   1. outlining the management of deep vein thrombosis, including circumstances where same-day diagnostic testing may be unavailable,

   2. listing indications and complications, and explaining management and monitoring of anticoagulant therapy,

   3. counselling the patient about anticoagulant therapy (prevention of post-thrombotic syndrome),

   4. investigating causes of deep vein thrombosis if indicated (e.g., thrombophilic states, underlying cancer),

   5. outlining the management of cellulitis, and

   6. determining if the patient requires other investigations (e.g., computed tomography angiography) or specialized care.