Idiopathic spontaneous compartment syndrome of the right lower limb: a case report

Abstract

Background Acutely painful lower limb is a common presentation to the emergency department, and acute compartment syndrome is an important differential diagnosis to consider given the correct predisposing history and clinical presentation. However, idiopathic spontaneous compartment syndrome is an uncommon occurrence. Case presentation A 54-year-old Caucasian man with no previous comorbidities presented with acute right-sided lower limb pain with classical symptoms showing gradual evolution. He had no other history of medical relevance and no preceding injury. Examination showed a marginally enlarged right lower limb with stretched skin and tenderness. Routine blood tests were normal including D-dimer levels. However, in the absence of any underlying risk factors, acute compartment syndrome was suspected on clinical merit and confirmed with magnetic resonance imaging. He underwent successful surgical intervention with fasciotomy and achieved good recovery. Discussion Acute compartment syndrome, though commonly attributed to trauma, can occur due to varied causes. Spontaneous acute compartment syndrome is attributed to diabetes mellitus. Idiopathic acute spontaneous compartment syndrome occurs in the absence of either intrinsic or extrinsic risk factors and is rarely documented in the literature. This case highlights the importance of appreciating classical clinical signs and having the clinical acumen to consider an obvious diagnosis even in its rarer form of presentation.

Spontaneous acute forearm compartment syndrome: Case report of a clinical diagnosis with limited imaging options

“…ACS can occur several months or even years after the trauma [8] . Idiopathic spontaneous ACS is an uncommon occurrence [3 , 4] . The term ‘spontaneous’ compartment syndrome has been used to suggest a non-traumatic cause such as diabetes mellitus, nephrotic syndrome, hypothyroidism, and secondary medication [8] .…”

“…Therefore, as little time as possible should be spent confirming the diagnosis [1] . Idiopathic spontaneous ACS is an uncommon occurrence [3 , 4] .…”

Compartment syndrome after transtibial anterior cruciate ligament reconstruction: A case report

“…Acute compartment syndrome is usually suspected from its classical presentation with the six P's: pain, pulselessness, pallor, paresthesia paralysis, and poikilothermia. These signs and symptoms are caused by rising intra-compartmental pressure and are time-dependent [10] . A monitoring device for intra-compartmental pressure was not available in our hospital, but diagnosis was mainly based on clinical observations, so intra-compartmental pressure was not required [10] .…”

“…These signs and symptoms are caused by rising intra-compartmental pressure and are time-dependent [10] . A monitoring device for intra-compartmental pressure was not available in our hospital, but diagnosis was mainly based on clinical observations, so intra-compartmental pressure was not required [10] . Therefore, we could treat the patient immediately after onset.…”