Disclosures: Min Yoo, MD: No financial relationships or conflicts of interest

Case Diagnosis: This is an atypical presentation of chronic exertional compartment syndrome secondary to untreated portal hypertension.

Case Description: 28-year-old man with history of cardiac cirrhosis and portal hypertension was referred to the PM&R clinic with presumptive diagnosis of peripheral neuropathy. He presented with a 4-month history of progressively worsening bilateral leg pain. His symptoms were severely exacerbated by walking and were localized to anterior and lateral legs without involving the feet or the thighs. ABI and venous Doppler were both negative. Subsequent X-ray and NCS/EMG of the lower extremities, as well as rheumatological work-ups were negative. Compartment pressure testing was performed and revealed significantly elevated pressures in anterior and lateral compartments bilaterally.

Setting: Outpatient PM&R ClinicAssessment/

Results: He was treated with diuretics with complete resolution of his symptoms within the next two weeks.

Discussion: Chronic exertional compartment syndrome is a common diagnosis in young athletes associated with age under 30, overtraining, anabolic steroid use, and aberrant running biomechanics (such as overpronation or rear foot ending). This individual did not have any of these commonly known risk factors aside from his age, however he did have an underlying medical comorbidity (portal hypertension) that led to fluid retention in his lower extremities and resulted in significantly elevated compartment pressures. Management of this condition includes physical therapy and activity modification, fasciotomy, botulinum toxin injections, and treatment of underlying medical comorbidities if applicable.

Conclusion: Fluid retention secondary to poorly controlled portal hypertension can lead to development of chronic exertional compartment syndrome and severe lower extremity pain.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/chronic-compartment-syndrome-in-portal-hypertension-a-case-report/