Clinical Capsule 3

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45-year-old obese male presents to the emergency department with pain and swelling in his left leg for the past 2 days. He reports that the leg feels tight and heavy, and the swelling has progressively worsened. He has a history of recent abdominal surgery 10 days ago is a smoker.

On examination:
Homan’s sign is positive

  1. Most likely diagnosis?
  2. How do you perform Homan’s sign
  3. Management
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Good one!

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Deep vein thrombosis (DVT)

Homan’s sign: Dorsiflex the foot while the knee is extended- pain in the calf indicates a positive sign.

Management:

  • Start anticoagulation (e.g., LMWH or DOAC)
  • Compression stockings
  • Monitor for signs of pulmonary embolism
  • Avoid massage or vigorous movements of the limb
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*Most Likely Diagnosis is
Deep Vein Thrombosis (DVT)
*Because their are Risk factors present:like
Recent surgery (abdominal surgery 10 days ago = major risk)
Obesity
Smoking
Immobility (post-surgery)
*Symptoms: swelling,pain and tightness or heaviness of leg.
*How to Perform Homan’s Sign:
With the knee extended, dorsiflex the foot abruptly.

Positive sign = Pain in the calf or posterior leg, suggesting irritation of the deep veins (DVT).

  • For management Anticoagulation therapy:
    Start Low Molecular Weight Heparin (LMWH) or unfractionated heparin, followed by
    Oral anticoagulants like Warfarin, Apixaban, or Rivaroxaban.
    Duration:
    First episode with transient risk factor (like surgery): 3–6 months of anticoagulation.
    Monitor INR if using Warfarin.
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