02/12/2010 at 5:51 AM Leave a comment

This man came in for a couple of things. One was his diabetes but he had problem with his leg. He walked in fine, he did not seem to be in any obvious discomfort. His Vital signs (temp, pulse, BP) were ok. He works hard so I suspected a strain, a hernia, a bruise or a joint problem.

OMG, or in this case OMGG(OH MY Good God!!!) He had a mass larger than a grapefruit. It was a wide as a grapefruit but a bit longer. It was indurated( Hard), part of it was infected. And did not seem all that tender. It went from the crease between the abdomen and thigh down halfway to his knee on the inside of the leg.

I had to pause to close my mouth. How long has it been this way, I ask? a couple of days he says. I stare at him, and he says perhaps a could of weeks. It seems he does not know, he noticed it a few days ago. How could you not know?  On the upper part the skin had changed to something we call Orange peel skin–not usually a good sign. It indicates that the lymphatic drainage system is compromised.

The posibilites were mixed. It is an unusual area to get a big abcess (which would be the best thing to have) and he did not have chills or fever and it did not hurt enough and was not red enough. It initially looked like he might have a superficial phlebitis (infection and clot of the vein) but again it wasnt tender enough and there wasnt enough colateral swelling. Also it was too big and wide. I was worried about a tumor, but that did not seem to fit either, a tumor of what?

I will keep you posted to how it turns out.


Entry filed under: Doctor Musings, true story. Tags: , .

Orange Insulin One day in Warsaw

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