ABSTRACT
This chapter provides a case study of 51-year-old man who presents to his GP with progressive swelling of the lower legs. He works as a teacher and had initially ignored the changes, assuming they resulted from standing all day. However, the swelling did not recede overnight and his shins were becoming ‘lumpy’. He feels otherwise well in himself, reporting plenty of ‘energy’ in the classroom, although he has lost weight which he cannot explain. There is a family history of varicose veins and diabetes. He takes occasional paracetamol for headaches and ‘tired eyes’ at the end of the day. There are bilateral pigmented plaques of the anterior shins, worse on the left than the right, and the associated swelling does not pit on firm pressure. There is no evidence of varicose veins. He has mild proptosis and clubbing, and is of slim build. There is no obvious swelling in his neck.
