Dr. Nadiminty Raghuvamsi
Surgical Oncology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hi doctor,
I am a 33 year old female. I have never smoked. I am not overweight and I do not have diabetes. I have been having some left leg issues. It started six months back. I started limping because my left calf, ankle and groin were hurting. My emergency Doppler venous ultrasound was clear. I had a D-dimer and that was negative. I had an MRI of my left ankle that showed a talofibular ligament sprain on my left ankle. I also had an arterial Doppler ultrasound that showed decreased flow of left anterior tibial artery and increased peak systolic velocity in the left common femoral artery. But, there was no stenosis, no sclerosis and no plaque. Could the sprain have caused that decreased flow? After three months, it became normal again. Then, while having pedicure the woman massaged my ankle and leg. Since then the pain has returned to my left ankle and left leg. I had another D-dimer done three weeks ago that was negative. I have also recently started experiencing cold left foot and a left cold lower leg at night. By morning, both the legs as well as the feet are of the same temperature. I do get pain in the buttocks and the pain is going down my leg like a sciatic pain on the left leg. Do I have peripheral artery disease? Could a blood clot be causing it? I have a four hours flight next week and I am worried about flying. Is it safe to fly? Would the arterial Doppler and D-dimer be able to tell if I have a blood clot in my artery? Or is a D-dimer just for the veins? My LDL (Low density lipoprotein)was 10 points above normal in my last blood test. But, my doctor did not seem to be concerned as my HDL (High Density Lipoprotein) was high. I have attached the reports for your reference. Please help me.
Hi,
Welcome to icliniq.com
From your description, I understand that the first time you had a problem with your left leg was due to a sprain (talofibular ligament) around the ankle and it got resolved. I suspect the same problem or something similar is causing you the pain again. It is highly unlikely for a 33 year old lady and a non-smoker to have a peripheral vascular disease. The arterial Doppler did show a decreased blood flow, but it might be due to a temporary spasm of the vessel than any specific pathology or disease. Moreover, no clot was found nor was there any change suggesting peripheral vascular disease. It is absolutely safe to fly and you need not worry about it. An arterial Doppler will be able to make out if you have a clot. D-dimer test is only for the veins and is not useful in arterial disease. I suggest you to look for causes either in your footwear or any strain which you have put repeatedly on your ankle causing repeated sprain in the left ankle. You can get an orthopedic consultation to be sure of the same. If he or she does not find any problem and your pain persists even after appropriate treatment then further evaluation can be done by a vascular surgeon. But, I do feel you may not require it.
Patient's Query
Thank you doctor,
From my report, are the findings significant enough to worry about? What could have caused the increased flow in the left common femoral artery? What are the possibilities of a clot at the old sprain site in the talofibular ligament? I know the question may sound silly, but sometimes internet sources can really scare a person to a point of anxiety. Do you think the left cold foot and leg symptoms just from the sprain being reinjured again from the ankle massage? And lastly, do you recommend to get another arterial Doppler of my left leg before I fly to rule out a clot? Or is it highly unlikely since I had one done just six months ago? Does an arterial blood clot present the same as a venous clot?
Hi,
Welcome back to icliniq.com.
There is nothing significant in your report to be worried about. The increased flow in the left common femoral artery is an incidental finding (just a comparative increase in relation to the right) as there was no stenosis or block noted, which are the usual causes. Internet sources do provide a lot of knowledge which cannot be understood by non-medical people in a holistic manner.Cold feet and leg can also be caused by neural problems, which is another cause. This has to be evaluated if the pain and other symptoms persist, especially as you complain of pain from the buttocks, etc. You do not need an arterial Doppler, it is highly unlikely to have clot. An arterial blood clot will present in an emergency manner with severe pain, redness, swelling, coldness, etc., while venous clot presents in a slow manner with progressive swelling, mild pain and low grade fever.
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Surgical Oncology
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