Sir, Arterial Doppler studies are an established procedure in the assessment of lower limb ulceration. The test is simple to perform, cheap and noninvasive but lacks the accuracy of angiography, which is regarded as the ‘gold standard’ in assessing atherosclerotic occlusive disease. Angiography is an invasive procedure with a risk of complications often requiring hospital admission. While arterial Doppler flow studies are regarded as noninvasive we report a patient where these were followed by the development of a large haematoma. A 93‐year‐old woman was admitted to hospital with a history of multiple falls and chronic leg oedema. Her medical history included asthma, diverticular disease and congestive cardiac failure with atrial fibrillation. She was taking 125 µg of digoxin, 2·5 mg of bendrofluazide and 5 tablets of coamilofruse 5/40 (amiloride hydrochloride 5 mg/frusemide 40 mg) daily. Her asthma was controlled with inhaled beclomethasone dipropionate (Becodisks®) 400 µg twice daily and salbutamol (Ventodisks®) 400 µg when needed which she had been taking for the last 10 years. She had had no systemic steroids in the past. There was no history of deep vein thrombosis or varicose veins. On examination of her lower limbs she had marked oedema extending to her thighs. There was a 5‐cm ulcer on the medial aspect of the left lower leg with a central 1‐cm necrotic area. Clinical assessment of the arterial flow to the legs was impeded by her marked oedema. It seemed likely that the ulceration on the gaiter area of the left leg resulted from trauma sustained during a recent fall. The ulcer had been treated with simple, nonadhesive dressings and crepe bandages applied by district nurses in the community.
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Gach et al. (2002) studied this question.