Clinical Practice and Cases in Emergency Medicine

Case Presentation: A 62-year-old male presented to the emergency department with a three-day history of right knee, calf, and foot pain following a bout of prolonged crouching while gardening. The physical examination revealed a cold and pale foot with absent pulses. A point-of-care ultrasound (POCUS) performed at bedside revealed a thrombosed popliteal artery aneurysm. A heparin infusion was initiated, and vascular surgery was consulted. Subsequent imaging confirmed the diagnosis of a thrombosed popliteal artery aneurysm with thrombus extension into the superficial femoral artery. The patient underwent a femoropopliteal bypass, resulting in successful revascularization of the limb.

Discussion: While POCUS is a well-established imaging modality for the diagnosis of deep vein thrombosis, its utility in diagnosing acute peripheral arterial pathologies is less well-known. This case demonstrates how prompt bedside POCUS evaluation can circumvent potential delays associated with traditional imaging such as computed tomography angiography, allowing for expedited surgical consultation and timely therapeutic and procedural intervention. This case highlights the potential role of POCUS in the rapid diagnosis of acute limb ischemia from arterial thrombosis in the acute care setting.