Q:

In a 55-year-old grocery store cashier with an 8-month history of leg edema increasing over the course of a work day, associated with moderate to severe lower leg bursting pain, the most appropriate investigative study or studies are:

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In a 55-year-old grocery store cashier with an 8-month history of leg edema increasing over the course of a work day, associated with moderate to severe lower leg bursting pain, the most appropriate investigative study or studies are: 


  1. Doppler duplex ultrasound.
  2. Brodie-Trendelenburg test.
  3. Ascending and descending phlebography
  4. Measurement of ambulatory and resting foot venous pressure.
  5. Venous reflux plethysmography.

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A. Doppler duplex ultrasound.

DISCUSSION: While the Brodie-Trendelenburg test was an early attempt to clinically evaluate valve competence and function, it is neither quantitative nor precise. The development of phlebography allowed anatomic delineation of normal and abnormal veins and, when used in combination with invasive measurement of venous pressures in the foot at rest and on ambulation, helped correlate the venous hypertensive state with postphlebitic changes. Noninvasive plethysmography to quantitate the degree of venous valvular incompetence was more easily accepted; however the combination of B-mode duplex ultrasound (to accurately locate the vein of interest) plus pulsed Doppler flow signal is now the “gold standard” for venous assessment.

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