December Case #3

65 y/o AAM presents to the ED with complaints of elevated blood sugar and lethargy. Pt denies pain, SOB, N/V/D, or trauma.

PMHx: DM, HTN
PSHx: none

Meds: ASA, Norvasc, HCTZ, Lisinopril, Insulin

Allergies: NKDA

FamHx: none

SocHx: none

PE: BP 109/77, P 86, R 16, T 98.1, POx 96% (RA)

GEN: thin AAF, lethgargic

HEENT: PERR, dry MM, no JVD

CHEST: CTA B, nonlabored

CV: RRR, no M/R/G
ABD: soft, NTND, + BS

EXT: no C/C, + edema to R arm extending from wrist to mid humerus, min TTP, no ecchymosis or erythema, ROM difficult to assess secondary to lethargy

Bedside ultrasound of the RU Ext performed with the following findings:

What is the diagnosis?


Thanks to Dustin Brimblecom for submitting this case!