In a patient with a history of DVT, what is the most likely finding in a unilateral swollen leg exam?

In a patient with a history of deep vein thrombosis (DVT), the most likely finding in a unilateral swollen leg exam is patent popliteal vein with incompetent valves. When DVT occurs, it can lead to venous insufficiency if the valves within the veins become incompetent as a result of the previous thrombotic event.

Incompetent valves fail to prevent the backflow of blood, resulting in venous hypertension and subsequent swelling in the affected leg. This aligns with the clinical observation of unilateral edema, where there is a significant discrepancy between the affected leg and the contralateral leg. The presence of a patent popliteal vein indicates that while blood can flow through this vein, the incompetence of the valves is contributing to the abnormal pooling of blood and swelling.

This understanding is crucial for recognizing the complications associated with DVT and the impact of venous valve function on leg swelling. Other findings such as obstructed veins or bilateral edema do not fit the typical presentation of DVT complications in this context, while increased blood flow may be present but does not specifically explain the unilateral swelling associated with previous thrombotic events.