Plantaris rupture: a mimic of deep venous thrombosis.
BACKGROUND
The differential diagnosis of non-traumatic lower extremity pain and swelling runs the gamut from simple musculoskeletal injury to a possibly life-threatening deep venous thrombosis (DVT). Although evaluation and management are often guided by physical examination and history, a diagnostic study is often required. Institutional factors surrounding diagnostic imaging often lead physicians to empirically treat these patients for DVT with a plan for definitive diagnosis at a later time.


OBJECTIVE
We discuss plantaris tendon rupture, the ability of the clinician to differentiate DVT from musculoskeletal injury, and the risks of anticoagulation in the setting of an undifferentiated, painful, swollen lower extremity.


METHODS
We report the case of a 57-year-old transgendered woman who presented with left lower extremity pain and swelling and was found to have a rare cause of tennis leg: plantaris tendon rupture.


CONCLUSIONS
Frequently, clinical examination and history are insufficient to distinguish DVT from musculoskeletal injury. In these instances, anticoagulation carries a risk of compartment syndrome and hemorrhage with uncertain benefit to the patient. A definitive diagnosis should be sought before initiation of anticoagulation of the swollen, painful lower extremity.
Lopez
Gregory J
GJ
Department of Emergency Medicine, NYU School of Medicine, New York, New York, USA.
Hoffman
Robert S
RS
Davenport
Moira
M
D003937:Diagnosis, Differential; D005534:Foot Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012422:Rupture, Spontaneous; D013710:Tendons / Q000000981:diagnostic imaging; D014189:Transsexualism; D020246:Venous Thrombosis / Q000175:diagnosis*