A 40-year-old Man with Severe Arm Pain, Swelling

Pt calls 911 for chest pain. In transit, signs, symptoms, history of the real problem are unmistakable. Your Dx?

A 40-year-old man complains of worsening left arm pain of 6 days’ duration; claims accident at construction site; 2 prior ED visits for x-rays; now claims “fever,” chest pain. Left arm severely edematous; admits to IV heroin use average 2x/day; last used 1 week ago.

What is your impression?