A 57-year-old man with history of hypertension presented with 6 days history of left lower extremity swelling, pain and purple discoloration. He denied shortness of breath, cough, chest pain or palpitations. He took hydrochlorothiazide for HTN. On presentation, his vital signs were stable and physical exam was remarkable for left leg pitting edema and tenderness to palpation of left calf with purple discoloration. His creatinine and BUN were elevated at 2.1 mg/dl (normal 0.6-1.2 mg/dl) and 31 mg/dl (normal 8-23 mg/dl), respectively. Rest lab results were within normal. The diagnosis of DVT was entertained and ultrasound (US) of the left legs showed acute thrombosis extending from the proximal to mid left common femoral vein into the left femoral profundus and origin of the left saphenous vein. The patient was started on heparin IV infusion and admitted to medical floor for further work-up. US of the kidneys showed left hydronephrosis which elucidated his worsening renal function.
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