Vascular Malformation of Lower Limb Masquerading as Varicose Veins in a Patient with Rheumatoid Arthritis -Case Report and Literature Review

We present a case of vascular malformation of the lower limb mimicking varicose veins. A 52-year-old female patient presented with bilateral severe arthritis of the knees due to rheumatoid arthritis. During total knee arthroplasty, there was a huge challenge in controlling the bleeding from large tortuous veins. Magnetic resonance venogram revealed vascular malformation involving the subcutaneous tissues. We present this case to highlight the need for a high index of suspicion whenever diffuse calcification involving soft tissue plane is noted in the radiographs. It is mandatory to do venous duplex ultrasonography for all patients with varicose vein and soft tissue opacities in the preoperative radiographs to prevent missing a vascular malformation before proceeding for surgery.