DVT - clinical exam

Q: 32 years old female is transferred to ICU with shortness of breath (SOB). On examination calf area in left lower extremity is noted to have swelling, edema, pain and warmth. Which of the following has the highest specificity for Deep Venous Thrombosis (DVT)? (select one)

A) swelling 

B) pain 

C) warmth 

Answer: C

DVT is the most probable diagnosis when a patient presents with unilateral (can be bilateral in some cases) lower extremity swelling, pain, warmth, and erythema, particularly when other clinical signs are present like SOB. 

The specificity for warmth, swelling and pain is 48, 33 and 19 percent respectively. In contrast sensitivity is 72, 97 and 86 percent respectively.

Few risk factors are:

• immobilization 
• prolonged hospitalization
• recent surgery
• trauma 
• obesity
• malignancy
• previous history
• oral contraceptives/hormone replacement therapy
• pregnancy
• postpartum status
• family history
• heart failure
• inflammatory bowel disease
• collagen-vascular disease
• myeloproliferative disorders
• nephrotic syndrome
• heparin-induced thrombocytopenia (HIT)
• liver disease

#vascular

#hematology

#clinical-exam

References:

1. Sandler DA, Martin JF, Duncan JS, et al. Diagnosis of deep-vein thrombosis: comparison of clinical evaluation, ultrasound, plethysmography, and venoscan with X-ray venogram. Lancet 1984; 2:716.

2. Kahn SR, Joseph L, Abenhaim L, Leclerc JR. Clinical prediction of deep vein thrombosis in patients with leg symptoms. Thromb Haemost 1999; 81:353.