A 45 year-old male with history of end-stage renal disease secondary to type 2 diabetes on hemodialysis presents with chief complaint of left hand pain and wrist swelling for the past 8 days.
The patient says his symptoms came on gradually and have been more or less persistent since onset. Pain is 3/10 and described as a dull ache. No history of trauma. He decided to come into the emergency department today because the pain and swelling do not appear to be getting any better and he is concerned. The patient says he was last dialyzed yesterday.
He denies having any recent fever, chills, nausea, vomiting, diarrhea, abdominal pain, chest pain, or shortness of breath.
On exam you note the presence of an arteriovenous fistula in the proximal left forearm with palpable and audible thrill to auscultation. Radial pulses are 3+ bilaterally with equal sensation and strength in both hands as well as full range of motion in both wrists and all digits. All joints in the left upper extremity are non-tender.
Can you guess the diagnosis?
Leave a comment below and tell us how you would manage this patient.
The actual diagnosis for this real-life case will be posted in 1 week.
Venous hypertension. Vascular surgery consult for AV fistula ligation.
ReplyDelete