Painful swollen leg - think beyond deep vein thrombosis or Baker's cyst

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The diagnosis of deep vein thrombosis of leg is very common in clinical practice. Not infrequently a range of pathologies are diagnosed after excluding a thrombosis, often after a period of anticoagulation.

Case presentation
This is a report of three patients who presented with a painful swollen leg and were initially treated as a deep vein thrombosis or a baker's cyst, but later diagnosed as a pleomorphic sarcoma, a malignant giant cell tumor of the muscle and a myxoid liposarcoma. A brief review of such similar reports and the relevant literature is presented.

A painful swollen leg is a common clinical scenario and though rare, tumors must be thought of without any delay, in a duplex negative, low risk deep vein thrombosis situation.


Painful swollen leg is a common clinical scenario. Deep vein thrombosis (DVT) often presents as a painful swollen leg and prompt management is vital to prevent fatal pulmonary embolism. The common differential diagnoses include cellulitis and a ruptured baker's cyst 1. Rare pathologies with a similar clinical picture to venous thrombosis of calf 2 and dual pathologies have been reported 1,3 including tumors 4. Careful evaluation is needed to avoid inappropriate management and vitally a catastrophic delay in initiating appropriate treatment. We report three case histories of patients managed initially as a DVT of calf or a baker's cyst and later referred to our centre with a provisional diagnosis of a soft tissue tumor.

Case presentation
Case 1

A 70 year old female presented to general practitioner with complaints of pain in left knee and calf. Initial knee radiographs showed early osteoarthritis. As there was associated calf tenderness she was admitted for further investigations. All blood parameters were normal. D-dimers at the time of admission were 440 ng/ml. She was categorized as moderate risk for a DVT on clinical examination. Anticoagulation was initiated suspecting a DVT and the Duplex scan of the leg was inconclusive.




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