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Dr. Nomi
Dr. Nomi, Doctor (MD)
Category: Health
Satisfied Customers: 1988
Experience:  Medical Doctor,UK
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Hi, I have an intermittently swollen (mild but noticeable)

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Hi, I have an intermittently swollen (mild but noticeable) right foot and calf associated with discomfort in my right iliac fossa. It has been particularly bad for the last three days. The two symptoms were initially unrelated. I first experienced the right iliac fossa pain 3 years ago and have since been investigated with ultrasound and CT scans which showed only possible early diverticula in the right colon and some small haemangioma in my spleen - but otherwise normal. The right iliac fossa discomfort is fairly constant though varying in severity. I first noticed the foot swelling after a flight to Uganda 2 and a half years ago. It subsided after a few days. The foot swelling comes and goes and only ever seems to last for a couple of days but I have noticed that it is usually when the right iliac fossa pain is particularly bad. I wondered whether there is a possibility that something is compressing something in my right iliac fossa to cause both local pain in that area and the swelling in my right foot?! I have a history of endometriosis (mild) shown at laparoscopy but otherwise well. No medications, no allergies.

Dr. Nomi :

Hi,

Dr. Nomi :

I feel like it is aneurysm of one of arterties of pelvis can be right iliac artery aneurysm which is giving such symptoms.You should go for a fresh ultrasonography and an angiography for abdominal blood veseels.

Dr. Nomi :

Aneurysms are best picked up on angiogram rather than ultrasound.

Dr. Nomi :

I am advising ultrasound as this will rule out endometriotic cysts if there any.

Dr. Nomi :

Regards

Customer:

I have already had an ultrasound of my abdomen and pelvis and it did not show anything. Is an aneurysm likely at my age (33)?

Dr. Nomi :

Yes,it is possible.

Customer:

Would neither the CT abdo/pelvis nor the ultrasound abdo/pelvis have picked an aneurysm up? Are there any other possible causes that you can think of?

Dr. Nomi :

Yes,CT can pick it up .But small aneurysm can be missed in the start of it.

Dr. Nomi :

Swelling of foot off and on also shows some link to blood supply of it.

Dr. Nomi :

This is just one possiblity .

Dr. Nomi :

How are your menses otherwise?

Dr. Nomi :

Are they regular?

Dr. Nomi :

Do this pain has link with menstrual flow?

Dr. Nomi :

Any other vaginal discharge?

Customer:

I have a fairly regular 30 day cycle. The first day of my last period was 10th November and it lasted for 3 days. My foot swelling started on 18th November. I am not on any contraceptive pill although have been in the past. I have not managed to relate the pain to my cycle, although occasionally the pain has been worse just before or just after my period but there's not enough consistency to make a link.

Customer:

No vaginal discharge

Dr. Nomi :

No urine or bowel problem?

Customer:

No urine problems. My bowels have been slightly constipated for the last few days but I have been passing stool and the discomfort and foot swelling continues.

Dr. Nomi :

Have you had weight loss in this time period?

Customer:

No. I weigh 11st6lbs, height 5ft 7 - If anything I have not been able to lose any weight. I have a good appetite.

Dr. Nomi :

nice.Have you ever hospitalized in your past?

Customer:

I have had a Bartholin's cyst quarterised - twice in 2005. I had a laparoscopy which revealed endometriosis in 2000.

Dr. Nomi :

When as your last ultrasound done?

Customer:

May 2012

Dr. Nomi :

its fresh one then.

Dr. Nomi :

Well,in the light of all this it can be just a choclate cyst or endometriotic cyst which is pressing on something.Or it is just a diverticula disease which is causing problem of pain and foot problem is unrelated with it.

Customer:

Should I be concerned about the right foot swelling/pain? Do you still think, in light of the above, that an aneurysm is a possibility?

Dr. Nomi :

Yes,if your CT was done a year ago then I do not think about aneurysm.

Customer:

I am sorry, I am not clear from your answer. You think an aneurysm is a possibility or it isn't? My CT was in April 2012.

Dr. Nomi :

As CT is fresh then I do not think it is aneurysm.

Dr. Nomi :

Probably it is diverticular disease which is causing pain.

Customer:

And the swollen right foot/calf?

Dr. Nomi :

There should be done separate doppler studies for foot to see its blood supply.

Customer:

Is there a possibility the foot/calf swelling is DVT or very unlikely, given that I have had it for so long and intermittently?

Dr. Nomi :

Are you having foot swelling for one year?

Customer:

I first had it in May 2010 after a flight to Uganda. It lasted for a few days. Then I have had it intermittently since. It only ever lasts for a few days and then it goes back to normal again. I often have it after I fly. But I also have it when I don't fly. For example this time, it started on 18th November. I haven't taken a flight since August. The swelling just suddenly came again.

Dr. Nomi :

It does not sound like DVT ,yes but doppler studies should be done .

Customer:

Thank you for your help. Best wishes Dr Nomi.

Dr. Nomi :

Welcome.

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