#june2020amc1
A 57-year-old woman presents with a three month history of leg ulceration. On examination there is a 6x3 cm superficial ulcer above the left medial malleolus. There is healthy granulation tissue in the floor of the ulcer. There is pigmentation in the surrounding skin, signs of lipodermatosclerosis and varicose veins running down the medial aspect of her left thigh and calf. The left femoral and popliteal pulses are palpable. The left foot pulses are not palpable but strong biphasic Doppler Signals were present over the posterior tibial and dorsalis pedis. The resting ankle brachial pressure ratio (ABPI) is 0.95. An arterial and venous duplex scan of the left leg is requested. Which one of the following is the scan most likely to show?
A. A deep vein thrombosis
B. An occlusion of the superficial femoral artery
C. Normal arteries and veins
D. Severe reflux at the saphenofemoral junction and within the long (greater) saphenous vein
E. Severe reflux in the popliteal vein
Explanatory Notes:
The symptoms and physical signs describe a typical chronic venous ulcer. The commonest cause of this is superficial venous incompetence. The distribution of varicose veins is consistent with SFJ and long saphenous incompetence.
A 57-year-old woman presents with a three month history of leg ulceration. On examination there is a 6x3 cm superficial ulcer above the left medial malleolus. There is healthy granulation tissue in the floor of the ulcer. There is pigmentation in the surrounding skin, signs of lipodermatosclerosis and varicose veins running down the medial aspect of her left thigh and calf. The left femoral and popliteal pulses are palpable. The left foot pulses are not palpable but strong biphasic Doppler Signals were present over the posterior tibial and dorsalis pedis. The resting ankle brachial pressure ratio (ABPI) is 0.95. An arterial and venous duplex scan of the left leg is requested. Which one of the following is the scan most likely to show?
A. A deep vein thrombosis
B. An occlusion of the superficial femoral artery
C. Normal arteries and veins
D. Severe reflux at the saphenofemoral junction and within the long (greater) saphenous vein
E. Severe reflux in the popliteal vein
Explanatory Notes:
The symptoms and physical signs describe a typical chronic venous ulcer. The commonest cause of this is superficial venous incompetence. The distribution of varicose veins is consistent with SFJ and long saphenous incompetence.
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