94 year old female, worsening right toe and foot pain. Seen by primary care and diagnosed as having gout. The clinical findings of critical limb ischemia - dry scaly skin, nail changes, absent pulses and a punched out ulcer on the 2nd toe - were ignored. Popliteal artery occlusion treated with atherectomy.
Recurrent lower extermity DVT should prompt an investigation for venous outflow obstruction. Too often these patients are under treated.
Painful varicoceles interfering with high school athletics
71 year old female with a non healing ulcer on the left foot.