A 65-Year-Old Man with Persistent Atrial Fibrillation Comes to the Emergency

question 135

Multiple Choice

A 65-year-old man with persistent atrial fibrillation comes to the emergency department with a cold right foot.  He has not been compliant with anticoagulation therapy.  His other medical problems include type 2 diabetes mellitus, hypertension, and chronic nephropathy with low-grade proteinuria.  The patient's blood pressure is 122/70 mm Hg and pulse is 112/min and irregular.  Physical examination shows a cold right leg with absent dorsalis pedis and posterior tibial pulses.  An emergency arteriogram reveals right popliteal artery occlusion, which is treated with thrombus aspiration with good angiographic results.  Two hours later, the patient has intense pain in the right leg, accompanied by an "ant crawling" and burning sensation.  Which of the following is the most likely diagnosis?

• A)Compartment syndrome
• B)Deep-tissue infection
• C)Diabetic neuropathy
• D)Ischemic stroke
• E)Phantom pain

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