Leg ulcers DDx

Overview

Leg ulcers may result from venous stasis, ischemia, malignancy, infection, neuropathy, trauma or underlying systemic disease.

Causes

Venous stasis ulcer – most common

  • Site: around malleoli
  • Associated pigmentation, stasis eczema

Ischaemic ulcer

  • Large artery disease (atherosclerosis, thromboangiitis obliterans): usually lateral side of leg (pulses absent)
  • Small vessel disease (e.g. leucocytoclastic vasculitis, palpable purpura)

Malignant ulcer

  • e.g. basal cell carcinoma (pearly translucent edge), squamous cell carcinoma (hard everted edge), melanoma, lymphoma, Kaposi’s sarcoma

Infection

  • e.g. Staphylococcus aureus, syphilitic gumma, tuberculosis, atypical Mycobacterium, fungal

Neuropathic

  • painless penetrating ulcer on sole of foot: peripheral neuropathy
  • e.g. diabetes mellitus, tabes, leprosy)

Underlying systemic disease

  • Diabetes mellitus: vascular disease, neuropathy or necrobiosis lipoidica (front of leg)
  • Pyoderma gangrenosum
  • Rheumatoid arthritis
  • Lymphoma
  • Haemolytic anaemia (small ulcers over malleoli), e.g. sickle cell anaemia

CCC 700 6

Critical Care

Compendium

Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health and Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of two amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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