Vascular Malformation of Lower Limb Masquerading as Varicose Veins in a Patient with Rheumatoid Arthritis -Case Report a
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Vascular Malformation of Lower Limb Masquerading as Varicose Veins in a Patient with Rheumatoid Arthritis -Case Report and Literature Review Palanisami Dhanasekararaja 1 & Dhanasekaran Soundarrajan 1 & Natesan Rajkumar 1 & Shanmuganathan Rajasekaran 1 Accepted: 27 August 2020 # Springer Nature Switzerland AG 2020
Abstract We present a case of vascular malformation of the lower limb mimicking varicose veins. A 52-year-old female patient presented with bilateral severe arthritis of the knees due to rheumatoid arthritis. During total knee arthroplasty, there was a huge challenge in controlling the bleeding from large tortuous veins. Magnetic resonance venogram revealed vascular malformation involving the subcutaneous tissues. We present this case to highlight the need for a high index of suspicion whenever diffuse calcification involving soft tissue plane is noted in the radiographs. It is mandatory to do venous duplex ultrasonography for all patients with varicose vein and soft tissue opacities in the preoperative radiographs to prevent missing a vascular malformation before proceeding for surgery. Keywords Vascular malformation . Varicose veins . Rheumatoid arthritis . Total knee arthroplasty . Klippel-Trenaunay syndrome
Introduction Vascular malformations (VM) are rare congenital angiodysplastic disorder. The spectrum of disorders ranges from simple venous, lymphatic or capillary malformations to complex arteriovenous fistulas [1]. Haemangiomas are capillary malformations characterised by endothelial proliferation and involutes before 10 years of age. Unlike haemangiomas, VM are congenital lesions due to a defect during vascular embryogenesis and will be present in the adults [2]. We present a missed case of vascular malformation of the lower limb mimicking varicose veins and consequent This article is part of the Topical Collection on Surgery * Dhanasekaran Soundarrajan [email protected] Palanisami Dhanasekararaja [email protected] Natesan Rajkumar [email protected] Shanmuganathan Rajasekaran [email protected] 1
Department of Orthopaedics, Ganga Hospital, 313, Mettupalayam road, Coimbatore 641 043, India
intraoperative challenges while doing TKA and narrative review of literature of this rare condition.
Presentation of Case A 52-year-old female presented with bilateral knee pain for the past 10 years. She was a known case of rheumatoid arthritis, and she was on steroids and disease-modifying agents. She had difficulty in doing activities of daily living and was housebound. On examination, she had engorged varicose veins over the leg (Fig. 1). Bilateral distal pulses were palpable with no neurological deficit. Her preoperative knee society score was 2, and her knee society functional score was 0. Radiographs revealed bilateral symmetrical arthritis of both knees with valgus alignment and severe patellofemoral arthritis. Soft tissue area showed diffuse calcification over the right lower limb, and the left side was normal (Fig. 2). Her coagulation profile was within normal limi
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