51-year-old woman with no past medical history got hit by a flying rock on the left shin 6 days ago. The pain was mild and she was able to go about the rest of her day without any problems. She is here in the urgent care today for gradual worsening of the redness and swelling but approximately the same level of pain. She also noticed bruising on the medial left foot today.
Patient denies taking any blood thinners, no herbals or supplements. Has a prescription for Albuterol which she doesn’t use but 1-2x per year and isn’t using currently.
She didn’t ice the area, didn’t elevate the leg, and didn’t have to take anything for the pain. Still going to work and besides the acute concerns as mentioned above she is still doing her normal routine.
No pain ambulating
On exam patient registers normal vitals.
Normal cardiopulmonary exam.
Distal pulses equal in the bilateral lower extremities.
There is a small eschar on the left proximal shin with surrounding edema, erythema, mild tenderness, calor which is surrounded by ecchymosis.
Distal to the injury there is 1+ pitting edema.
Negative Homan’s sign.
There is ecchymosis on the medial and lateral aspect of the lower extremity.
Diagnosis: erythema due to hematoma with mild skin necrosis
Treatment: topical medium potency steroid for 5-7 days, icing 3x per day. Leg elevation.
DDX: cellulitis, DVT.