New considerations in the diagnosis and therapy of deep vein thrombosis.

The cause of thrombosis is often unknown but is universally ascribed to part of Virchow's triad: stasis, hypercoagulability, and intimal injury. Venous thromboembolic disease is a common and costly medical problem, with iliofemoral deep vein thrombosis (IFDVT) being a less common but often underestimated presentation of this condition. Treatment options for deep vein thrombosis (DVT) have expanded in recent years and now include systemic anticoagulation, thrombolytic therapy, and surgery. Several studies have shown the efficacy of catheter-directed thrombolytic therapy in resolution of IFDVT. There is also growing evidence that early lysis is more likely to preserve valve function leading to a decrease in the incidence of postthrombotic syndrome, which is a known long-term complication of DVT and IFDVT. The following case report describes a patient, without malignancy, who had an atraumatic iliac and femoral DVT and illustrates the diagnostic considerations and therapy of a patient with iliofemoral DVT.

Lisfranc injury of the foot: a commonly missed diagnosis.

Lisfranc joint injuries are rare, complex and often misdiagnosed. Typical signs and symptoms include pain, swelling and the inability to bear weight. Clinically, these injuries vary from mild sprains to fracture-dislocations. On physical examination, swelling is found primarily over the midfoot region. Pain is elicited with palpation along the tarsometatarsal articulations, and force applied to this area may elicit medial or lateral pain. Radiographs showing diastasis of the normal architecture confirm the presence of a severe sprain and possible dislocation. Negative standard and weight-bearing radiographs do not rule out a mild (grade I) or moderate (grade II) sprain. Reevaluation may be necessary if pain and swelling continue for 10 days after the injury. Proper treatment of a mild to moderate Lisfranc injury improves the chance of successful healing and reduces the likelihood of complications. Patients with fractures and fracture-dislocations should be referred for surgical management.