Case 1: A 44-Year-Old Woman Presented With Unexplained Painful Left Leg Swelling

Dr. Myunhee Lee: A 44-year-old woman with no previous medical history presented with painful, gradually worsening left leg swelling for two weeks. She denied smoking, drinking alcohol, oral contraceptive use, or illicit drug use. She had no history of recent surgery, trauma, or travel leading to prolonged immobilization. She had no complaints of sexual intercourse. She had no abdominal or hip pain. On physical examination, she was afebrile and vital signs were stable (the temperature was 36.6°C, the blood pressure 122/62 mmHg, the pulse 66 beats per minute, the respiratory rate 16 breaths per minute, and the oxygen saturation 98% while the patient was breathing ambient air). The body weight was 65 kg with a body-mass index of 26.7. Both lungs were clear. The heart sounds were normal, without murmurs. Her left lower extremity from the ankle to thigh was swollen and tender with mild erythematous change but without any skin lesion (Fig. 1). She had no swollen or palpable lymph node in groin area. Other examinations were unremarkable. Both femoral and distal pulses, motor strength, and sensations were intact. Laboratory tests, including complete blood count, complete metabolic panel, and urinalysis, were unremarkable except for an elevated D-dimer level (4.34 mg/L FEU). Antiphospholipid syndrome was ruled out as anticardiolipin antibodies, and lupus anticoagulants were normal. Coagulopathy panels including protein S, protein C, and factor V laden were within reference ranges, and thrombophilia tests were negative. An electrocardiogram showed sinus rhythm. Chest radiograph showed clear lungs and normal cardiac and mediastinal silhouette.