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Ischaemic foot: an unusual cause
  1. M H Shiwani,
  2. S Bashker,
  3. A M M Basheer,
  4. P J Curley
  1. Department of Vascular Surgery, Pinderfield and Pontefract NHS Trust Hospitals, West Yorkshire, UK
  1. Correspondence to:
 Mr M H Shiwani, Barnsley District General Hospital, Gawber Road, Barnsley S75 2EP, UK

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A 15 year old boy presented with a four month history of intermittent claudication of right calf at 500 yards, which gradually got worse and he subsequently developed numbness and discoloration of the right foot. He was a non-smoker, non-diabetic, and there was no history of cardiovascular, respiratory, or haematological disorders. There was no history of trauma, burns, or radiotherapy. His height was 1.88 m and weight 92.4 kg (body mass index = 26). On examination he was normotensive with normal heart sounds and in sinus rhythm with no carotid bruit or aneurysm of the aorta or peripheral arteries. He had a full complement of pulses on the left leg. On the right leg popliteal and foot pulses were not palpable. The right leg was cold below the mid-calf. There was no neurological deficit and no tissue loss. Ankle brachial pressure index of the right dorsalis pedis was 0.28 and left dorsalis pedis was 1. Blood tests including full blood count, clotting time, C reactive protein, liver function test, thyroid function test, rheumatoid factor, autoimmune antibodies, and cholesterol were all within the normal range. The Duplex scans of his right leg arteries are shown in figs 1 and 2. A magnetic resonance angiogram (MRA) is shown in fig 3.

Figure 1

Duplex scan of his right femoral artery.

Figure 2

Duplex scan of his right popliteal artery.

Figure 3

Magnetic resonance angiogram.

QUESTIONS

  1. What do the Duplex scans show?

  2. What does the MRA show?

  3. What are the causes of ischaemic foot?

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