• question-icon

    Suggest treatment for pain and swelling in the right foot

default
Posted on Mon, 2 Jan 2017 in Hypertension and Heart Disease
Question: Hi Doctor,

My mother has a swelling, pain and feeling of heaviness in the right foot for the last 2 weeks. After consulting a vascular surgeon and performing Ultra sound dopplers and CT Angio, the reports gave the following details. He then asked us to consult the interventional cardiologist and ask his opinion of inserting a stent.

I need an understanding of the medical terms used and the implications.

Right mid and distal external iliac artery shows contrast filling defect with few collaterals s/o thrombosis.

Left mid anterior tibial artery is narrow in calibre with reduced contrast opacification. Distal left anterior tibial artery is not visualised.

Right mid peroneal artery is thinned out. However show adequate contrast opacification.

What does reduced and adequate contrast opacification mean? What are the risks of the left artery not being visualised and right mid peroneal artery thinned out?

Thanks,
xxxxxxxxxxxxxxx
doctor
Answered by Dr. Rishu Saxena 1 hour later
Brief Answer:
Radioogical terms explained in detail

Detailed Answer:
Hi ,
Firstly thanks for selecting HCM to ask your query,

Before coming to technicalities like filling defect and opacities, i would like to give you a brief idea of how lower limb is supplied,it will help to understand your queries better;

The external iliac artery arises from the bifurcation of the common iliac artery. The abdominal aorta divides to form the "common iliac arteries" in the lower abdomen, and these vessels supply blood to the pelvic organs, gluteal region(thigh), and legs.Each common iliac artery descends and divides into an internal and an external branch.

' The external iliac artery provides the main blood supply to the legs"
Doctors use to inject a contrast XXXXXXX into the blood ,this XXXXXXX is distributed into the whole body, if blood supply to a particular part or rather blood flow in a particular vessel is normal XXXXXXX would be conducted to that vessel along with blood;The machine used in CT-angio will pick up the flow of XXXXXXX in a particular blood vessel XXXXXXX is radioactive in nature ;and the machine will pick up these radiations.
FILLING DEFECTS means that when blood flow is restricted in a particular area then it will appear darker in respect to where flow of XXXXXXX is normal .
A clot(thrombus) appears darker in comparison to area which are brighter due to normal flow of XXXXXXX

Mid and lower part of ex.t iliac artery showing filling defect means that clots in that area preventing the blood containing XXXXXXX to flow properly ,picked by machine as darker area called filling defects medically.

Few COLLTERALS - when main artery is blocked our body has a natural mechanism to generate new artery (small) called collateral, in easy language if national high way is blocked ;we use to take a small road with many diversions ;which although is not as good as highway but can help to clear jam,In the same way when big vessels of body are blocked ,body generates small collateral vessels ,in a attempt to restore blood supply, presence of collateral signifies severe clots in main vessel.
Anterior tibial artery is there in lower part of leg;
Reduced contrast opacification again is a synonym of filling defects , a XXXXXXX contains iodine which acts as a contast media(on a black background it shines as bright i.e contrast)
Now as the XXXXXXX is not filling the artery due to reduced blood flow,A reduced contrast opacification is seen,In medical terminology we use word opacification for brightness, so in lay mans language reduced opacification means less bright images and adequate opacification means normal bright image of radioactive XXXXXXX .

peroneal artery branches out from tibial artery and supplies the lateral compartment of leg ,mid peroneal thinning means that the artery is having plaques(deposition or blockage)in middle part leading to reduced inner space ,as most of the space is occupied by clots and depostions;Medically termed as thinning ;but still the blood supply is adequate to keep muscles alive,adequate does not means normal ,it means for the time being its sufficient.
As its thinned at present which means that some amount of blood is still flowing through it which supplies the muscles in lateral compartment,as this thinning will increase blood supply will decrease leading to intolerable pain and atrophy of muscles supplied.
Left tibial artery not being visualised means that the artery is 100% blocked ,and there is no blood perfusion into it,the area supplied by this artery depends totally on collaterals,The key function of this artery is to supply blood to the muscles in the anterior (front) part of the leg,If not operated or stented soon the muscles and bones supplied by that artery will start to die causing intolerable pain .

Thank you
In case you need more details i would be happy to help!

Dr Rishu Saxena
Cardiologist XXXXXXX Hospital Newdelhi
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
default
Follow up: Dr. Rishu Saxena 3 hours later
Hi Doctor,

Thanks a lot for answering my question with a lot of details.

I have two more questions. The CT Angio of abdominal area of my mother revealed the following findings.

Atherosclerotic changes noted in aorta (more in infrarenal aorta) and its branches.

Ostial narrowing noted at left renal artery origin.

Incidentally noted umbilical hernia through a defect of size 2.5 mm with omental fat herniating through it.

Kindly explain the implications and the actions to take to improve the condition of my mother's health.

Thanks,
xxxxxxxxxxxxx
doctor
Answered by Dr. Rishu Saxena 40 minutes later
Brief Answer:
multiple specialities should decide what can be the cause.

Detailed Answer:
Hi Again,
As per the history given by you;
your mother's body has tendency to form atherosclerotic clots .Gradually every major blood vessel in her body is getting plaqued.
Earlier she got stented in left and right carotid artery and her heart and now her lower limb vessels and abdominal aorta is having the same problem.

My XXXXXXX opinion is that she is having some rare syndrome or inflammatory or thrombotic condition inside her body ,which is involving every blood vessel slowly.

Carotid is a branch of thoracic aorta , coronary originates from aorta ,external iliac originaes from abdominal aorta,renal artery arises from aorta, this condition is effecting all tributaries of aorta .

A very detailed investigation would be required to rule out the cause of these changes,as unless we know the cause we can't treat it.

It can be because of LUPUS or Inflammation of unknown origin ,or some genetic mutation.When you have lupus, your immune system cannot tell the difference between these foreign invaders and your body’s healthy tissues, so autoantibodies are made that damage and destroy healthy tissue.

See this is a rare case scenario ,normally womens have a hormone called estrogen which is highly cardio protective ,hence a CAD in a female less then 65 years of age is called early presentation of CAD.In your mothers case almost all branches of aorta are blocked in early 50's.

I would suggest you to consult a Rheumatolgist ,Medical genetics specialist,cardiologist,vascular surgeon and endocinologist and request them to discuss the case and possibilities together . Many specialities have to discuss this case to come to a conclusion, and you have to follow what ever they advice.

Umbilical hernia is a small problem don't worry about it now.

If possible, if you are in XXXXXXX message me your location, as it would be better to get a consultation at medical college or apex research centre in XXXXXXX and i could suggest you one.

I hope you can understand the gravity and intensity of problem , so conclusions and suggestions cant be given without detailed investigations.Once we find the cause we can stop it!

In case you have any further query ,you can ask me!
If you are helped by my answer do rate it.
Thank you!

Dr Rishu Saxena
Cardiologist


Above answer was peer-reviewed by : Dr. Prasad
doctor
Answered by
Dr.
Dr. Rishu Saxena

Cardiologist

Practicing since :2012

Answered : 696 Questions

premium_optimized

The User accepted the expert's answer

Share on

Recent questions on  Ultra sound

doctor1 MD

I had an operation tor correct testicular torsion when i was a teenager. I have suspected it has come undone, or the sutures are getting tangled. I...

doctor1 MD

Hi, I m Premkumar and this query is related to my daughter s health Problem. Her name is P. Srinitha and we live in Bangalore. She is 7 Yrs and 5...

doctor1 MD

Yes. My 11 year old son has been ill since last Thursday. His symptoms have been high temperature up to 105.5, minor abdominal pain, and persistent...

doctor1 MD

Hi. I am a 29 years old man. It is for about 5-6 months that i feel pain in my left testicle as well as a sharp pain in my left Buttocks. I have...

doctor1 MD

I started having symptoms about 7 weeks ago. Head congestion, then chest congestion, some fever, a cough, shortness of breath , and now pain in my...

doctor1 MD

I m freaking myself out that I have bladder cancer! I ve had frequent urination for about two months. Now I m having dull pains and cramps on my...

doctor1 MD

I’ve had a month of upper left rib pain , right near the left breast area. Had ultra sound chest X-ray, both normal, but spleen a bit enlarged...

Get personalised answers from verified doctor in minutes across 80+ specialties

142 Doctors Online

By proceeding, I accept the Terms and Conditions

HCM Blog Instant Access to Doctors
HCM Blog Questions Answered
HCM Blog Satisfaction
Questions Answered By Dr. Rishu Saxena
  • Q - Suggest treatment for severe gastritis post coronary angioplasty

  • Q - What causes persistent chest discomfort and heart palpitations?

  • Q - What causes sudden onset of heaviness in the left side of the chest?

  • Q - What causes persistent high blood pressure when diagnosed with atrial...

  • Q - What causes high blood pressure while treating polymyalgia rheumatica?

  • Q - Does BP medication cause diarrhea and constipation?

  • Q - What causes pneumonia while having chronic obstructive pulmonary disease?

  • Q - What does this echocardiogram report indicate?

  • Q - What causes frequent episodes of extreme breathlessness?

  • Q - What causes pain in the chest upon exertion?

backtotop2