Acute compartment syndrome (ACS) is a surgical emergency which requires prompt identification andintervention to prevent irreversible tissue damage. Here we present the case of a 64-year-old male withlower extremity tenderness following a crush injury. This patient presented to the emergency department(ED) more than 12 hours after the initial incident occurred and was found to have a firm right calf withdecreased sensation and absent distal pulses on his right leg. The patient’s outer compartment pressuremeasured 32 mmHg. Because these findings were concerning for acute compartment syndrome, emergentfasciotomies of the four compartments of the lower right leg were performed with improvement inneuromuscular compromise. Early identification of the condition permitted a prompt recovery for the patientwho was discharged home on day five. This case report reviews the clinical presentation and interventionalmodalities and aims to provide new images to help visualize a diagnosis of ACS.