Deep vein thrombosis history and symptoms: Difference between revisions
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{{Deep vein thrombosis}} | {{Deep vein thrombosis}} | ||
==Overview== | ==Overview== | ||
A proper history and physical exam is very important for establishing an accuracy diagnosis of [[DVT]] or [[VTE]]. One of the first steps in the management of [[DVT]] is the determination of [[Pretest probability of DVT#Wells score|Wells score for DVT]]. Out of the 10 clinical questions in the score, 9 can be ascertained solely on the basis of history and physical exam. This underscores the importance of these variables. A high index of suspicion is also necessary to diagnose [[DVT]]. | |||
==History== | ==History== | ||
In patients having known [[Deep vein thrombosis risk factors|risk factors]], a careful history should be taken. It must include the following: | In patients having known [[Deep vein thrombosis risk factors|risk factors]], a careful history should be taken. It must include the following: | ||
*History of any recent surgical procedure. | * History of any recent surgical procedure. | ||
*Use of [[hormonal contraception]], containing [[estrogen]] | * Use of [[hormonal contraception]], containing [[estrogen]]. | ||
*Recent long-haul flying | * Recent long-haul flying. | ||
*History of [[miscarriage]] (which can be a feature of thrombosis and several other disorders). | * History of [[miscarriage]] (which can be a feature of thrombosis and several other disorders). | ||
A family history can reveal a [[genetic disorder|hereditary]] factor in the development of DVT. A '''positive family history''' | * A family history can reveal a [[genetic disorder|hereditary]] factor in the development of DVT. A '''positive family history''' in one or more first-degree relatives under age 50 suggests the presence of a hereditary defect and/or an increased susceptibility for [[VTE]].<ref name="pmid19307525">{{cite journal| author=Bezemer ID, van der Meer FJ, Eikenboom JC, Rosendaal FR, Doggen CJ| title=The value of family history as a risk indicator for venous thrombosis. | journal=Arch Intern Med | year= 2009 | volume= 169 | issue= 6 | pages= 610-5 | pmid=19307525 | doi=10.1001/archinternmed.2008.589 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19307525 }} </ref> | ||
<gallery> | <gallery> | ||
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==Common Symptoms== | ==Common Symptoms== | ||
The classical symptoms of DVT include: | The classical symptoms of DVT include: | ||
*[[Pain and nociception|Pain]] in the affected area. | * [[Pain and nociception|Pain]] in the affected area. | ||
*[[Swelling]] of the affected area. | * [[Swelling]] of the affected area. | ||
*Dilation of the surface veins and [[erythema]] of the overlying area. | * Erythema around the affected area. | ||
* Dilation of the surface veins and [[erythema]] of the overlying area. | |||
However, sometimes there may be no symptoms referable to the location of the DVT. | |||
There are several techniques during physical examination to increase the detection of DVT, such as measuring the circumference of affected and the contra-lateral limb at a fixed point, and palpating the [[vein|venous]] tract, which is often tender. Physical examination is unreliable for excluding the diagnosis of deep vein thrombosis and [[Homans sign]] is not recommended for this. | |||
==Less Common Symptoms== | ==Less Common Symptoms== | ||
In | In [[phlegmasia alba dolens]], the leg is pale and cold with a diminished arterial pulse. | ||
In '''[[phlegmasia cerulea dolens]]''', there is an acute and near-total venous occlusion of the entire extremity outflow, including the iliac and femoral veins. The leg is usually painful, cyanosed and edematous | In '''[[phlegmasia cerulea dolens]]''', there is an acute and near-total venous occlusion of the entire extremity outflow, including the iliac and femoral veins. The leg is usually painful, cyanosed and edematous. | ||
==References== | ==References== | ||
Revision as of 01:48, 15 May 2012
Editors-in-Chief: C. Michael Gibson, M.S., M.D. Associate Editor-In-Chief: Ujjwal Rastogi, MBBS [1]
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Overview
A proper history and physical exam is very important for establishing an accuracy diagnosis of DVT or VTE. One of the first steps in the management of DVT is the determination of Wells score for DVT. Out of the 10 clinical questions in the score, 9 can be ascertained solely on the basis of history and physical exam. This underscores the importance of these variables. A high index of suspicion is also necessary to diagnose DVT.
History
In patients having known risk factors, a careful history should be taken. It must include the following:
- History of any recent surgical procedure.
- Use of hormonal contraception, containing estrogen.
- Recent long-haul flying.
- History of miscarriage (which can be a feature of thrombosis and several other disorders).
- A family history can reveal a hereditary factor in the development of DVT. A positive family history in one or more first-degree relatives under age 50 suggests the presence of a hereditary defect and/or an increased susceptibility for VTE.[1]
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Front View:Edematous Right Leg
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Rear View:Left limb edema localized to calf.
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Front View:Left limb edema localized to calf.
Common Symptoms
The classical symptoms of DVT include:
- Pain in the affected area.
- Swelling of the affected area.
- Erythema around the affected area.
- Dilation of the surface veins and erythema of the overlying area.
However, sometimes there may be no symptoms referable to the location of the DVT.
There are several techniques during physical examination to increase the detection of DVT, such as measuring the circumference of affected and the contra-lateral limb at a fixed point, and palpating the venous tract, which is often tender. Physical examination is unreliable for excluding the diagnosis of deep vein thrombosis and Homans sign is not recommended for this.
Less Common Symptoms
In phlegmasia alba dolens, the leg is pale and cold with a diminished arterial pulse.
In phlegmasia cerulea dolens, there is an acute and near-total venous occlusion of the entire extremity outflow, including the iliac and femoral veins. The leg is usually painful, cyanosed and edematous.
References
- ↑ Bezemer ID, van der Meer FJ, Eikenboom JC, Rosendaal FR, Doggen CJ (2009). "The value of family history as a risk indicator for venous thrombosis". Arch Intern Med. 169 (6): 610–5. doi:10.1001/archinternmed.2008.589. PMID 19307525.