A 50-year-old woman presents with bilateral leg swelling, pitting edema, and chronic skin changes (lipodermatosclerosis, haemosiderin deposits) without varicosities. Duplex ultrasound shows bilateral deep vein incompetence. What is the most likely diagnosis?

• A Primary varicose veins with superficial venous insufficiency
• B Primary lymphoedema
• C Post-thrombotic syndrome (chronic venous insufficiency from deep vein damage) ✓
• D Bilateral cellulitis

Explanation

Post-thrombotic syndrome (PTS) is the most common long-term complication of deep vein thrombosis, occurring in 20-50% of patients with DVT. It results from deep vein valve destruction and recanalization causing persistent deep venous hypertension. Clinical features include chronic edema, heaviness, pain, skin changes (lipodermatosclerosis, haemosiderin deposits), and ultimately venous leg ulceration. Duplex ultrasound confirming deep vein reflux distinguishes PTS from superficial venous insufficiency. Management includes compression therapy, leg elevation, and wound care for ulcers.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.