Fluid collection in calf

[Maureen Vaughan]

Started my NLP in November and have been progressing since. Currently on vacation and away from the lifting for 2 weeks, so my last day in the gym, coach and I worked on determining my best single rep weights for several of the lifts. These all went well; no pain or other indications of injury that day or even the next.

The second day after that gym session, I spent ~20 hours traveling, including a 9-hour flight. Next day, my ankles and calves were a bit swollen (not unexpected). The right quickly returned to normal, but the left continued to remain swollen with some degree of discomfort with walking and some overlying redness.

I ended up in the ER with concerns for a possible DVT. Imaging showed no clots but did find a “fluid collection in the medial calf measuring 2.8 x 1.1 x 11.3cm, possibly hematoma, less likely abscess”. I was placed on antibiotics (clindamycin and keflex) due more to concerns for an overlying cellulitis than an abscess.

The apparent cellulitis has resolved. There has been not one single sign of bruising anywhere in the calf, ankle, or foot, but the entire leg from the knee down remains edematous.

I have follow-up set for after I return home. I’m working on minimizing the swelling as much as I can in the meantime. The antibiotics were completed several days ago with no worsening of symptoms.

My question is whether anyone has seen a large hematoma (presumably) like this from lifting in the absence of any pain or other symptoms at the time, and if so, was there any underlying cause that led to it?

Thank you.

[Mark Rippetoe]

Is there a visible bruise?

[Lost and Found]

knee sleeves or wraps when training?

[Maureen Vaughan]

No, no visible bruise at any point since this started.

The only external sign (aside from the edema) was a brawny reddish color from my medial malleolus/anterior ankle crease to about halfway up the calf. There was some questionable warmth to that area as well, which is what led the ER doc to put cellulitis in the list of possibles and to start the antibiotics.

[Mark Rippetoe]

No bruise, no hematoma. And they cleared you from DVT. And you saw the images and you know there's no DVT. And there is no pain. Have you tried a compression sock?

[Maureen Vaughan]

I watched the images on the screen as the tech did the imaging. I’m pretty comfortable looking at images, and there was no clot visualized. The fluid collection was somewhat compressible under the wand (more like if you press in the middle of a long balloon), and it was uncomfortable when the tech did so.

There was no pain during my last session at the gym before I left town. The days after I travelled up until I went to the ER, I had discomfort in the calf, especially when walking, but it didn’t rise to the point I’d call it pain. There was also some discomfort if the reddened areas of the skin was touched, but again, not horrible. Once I started the antibiotics, that all pretty much cleared up, and all I’m left with is some discomfort when the calf stretches and stiffness/irritation due to the swelling.

I’ve been wearing a compression sock off and on. It doesn’t stop the ankle/leg from swelling during the day, though it might not be as bad by day’s end. This morning, even before I got out of bed, the foot, ankle, and calf are all significantly swollen, hardly at all improved overnight as it usually is, so the sock goes back on for the day.

With the foot now swollen, it does seem to be acting more like a really deep bruise, albeit one with no external purpling, with it slowly migrating down due to gravity. I’m just stumped as to how/why it happened with no known injury.



And no, Lost and Found, no knee sleeves or wraps when training.

[Mark Rippetoe]

I think you need a second opinion TOMORROW.

[Maureen Vaughan]

Unfortunately, I’m flying home tomorrow. I can get my brother (ortho doc) to look at it for me when I get back into town on Saturday, and I do have follow-up with my primary care doc arranged, as well. If needed, I know which ER to head to at home better than guessing which is the best here.

Thank you.

[Jdcuth]

Not entirely typical but I wonder if this was a ruptured Bakers cyst? I've not dealt with these for years so not too sure. I think your ortho relative will have the best insight

[Maureen Vaughan]

Two weeks later…

The fluid collection appears to have been the result of severe thrombophlebitis, likely due to my travel plus being on IVIG (known to be pro-thrombotic).

I’m on my second round of antibiotics (doxy this time) with improvement in the redness and warmth, though I’m still having significant swelling and ankle pain.

Next step looks like reimaging of some sort with consideration of drainage by interventional radiology if the fluid collection is still present, rather than the swelling being simply persistent edema.