Clinical radiology
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Phlebography is frequently requested to confirm or exclude deep venous thrombosis in patients presenting with a painful, swollen calf or leg. We have noted a small proportion of those with negative phlebograms to have compression or lateral deviation of the popliteal vein. These patients were submitted to contrast arthrography. ⋯ The optimum diagnostic strategy in patients with a swollen, painful leg is firstly to perform ultrasound of the femoral vein and popliteal fossa to exclude obvious thrombus or ruptured Baker's cyst. If this examination is negative, or a Baker's cyst is shown with no evidence of rupture, phlebography should be performed to exclude calf vein thrombosis. If this examination is negative, but a Baker's cyst is present, or deviation or compression of the popliteal vein is detected, contrast arthrography is suggested to look for rupture of the cyst.