Adz P
Introduction
Acute limb ischaemia is a time-critical vascular emergency classically associated with older patients and established risk factors. Atypical presentations in younger individuals are rare but may result in diagnostic delay, particularly in emergency settings where risk stratification guides decision-making. Failure to recognise such presentations can lead to significant morbidity.
Methods
A 27-year-old previously healthy female presented with an acute onset of left leg pain following exercise. She was an active cyclist with no significant past medical or family history of thromboembolic disease. Initial clinical assessment was unremarkable, with preserved peripheral pulses and capillary refill, and she was discharged with a presumed musculoskeletal diagnosis. She re-presented with persistent, worsening pain; duplex ultrasound was normal. On further presentation, she developed contralateral leg swelling, progressing to bilateral symptoms. Repeat ultrasound imaging remained inconclusive.
Results
In the context of ongoing symptom progression despite multiple attendances, CT imaging was performed, demonstrating three arterial emboli in the left lower limb. The patient underwent urgent surgical intervention. Subsequent history identified the use of the combined oral contraceptive pill as a potential prothrombotic risk factor.
Conclusions
This case highlights the diagnostic challenge of acute limb ischaemia in young, low-risk patients. Cognitive biases, including anchoring to initial benign diagnoses, may contribute to delayed recognition. The patient reported feeling unsupported and required persistent self-advocacy to obtain CT imaging. Persistent or evolving symptoms should prompt early reconsideration and advanced imaging, as delays may result in avoidable morbidity.
Authors
Aadya Prakash, University of Leeds, Leeds, United Kingdom