Chief Complaint: Knot to the left arm.
History of Presenting Illness: A 39-year-old African-American female, with past medical history significant for hypertension, end-stage renal disease on dialysis, three year old AV fistula, presented with the chief complaint of swelling in the left arm. She stated that the area had been gradually enlarging for the past three weeks, and after a successful dialysis yesterday, the area abruptly increased in size and became very painful. She was advised to go directly to the emergency room, but elected to go home. At home, she attempted acetaminophen, but the pain continued.
Review of Systems: Denies fever, chest pain, prior mastectomy, DVT, SOB, or rash. The remainder of systems review was otherwise negative.
Physical Exam:
VITAL SIGNS: T 98.1, P 99, R 16, BP 195/123.
GENERAL APPEARANCE: A well-developed, well-nourished African-American
female, nontoxic in appearance.
LUNGS: Clear to auscultation bilaterally. No crackles or wheezes.
CARDIOVASCULAR: RRR no MRG.
ABDOMEN: soft, NT.
SKIN: Shows an remarkably swollen area over her dialysis fistula site, measuring approximately 6cm X 8cm. Bruit is present in fistula. The area is very tender to palpation. Distal to the site, the patient is neurovascularly intact. No drainage is noted and no evidence of bleeding is seen.
MUSCULOSKELETAL: Has abnormality as listed above, but otherwise no acute
abnormalities.
Click here for images and video
|