Radiologic diagnosis of cerebral venous thrombosis and its differential diagnosis poster no c0628 congress. The diagnostic workup of suspected deep vein thrombosis or pulmonary embolism includes the sequential application of a clinical decision rule and ddimer testing. Ultrasound diagnosis of deep venous thrombosis request pdf. Dvt diagnosis requires the use of imaging devices such as ultrasound. Although ddimer is elevated in patients with dvt, it is also elevated in a variety of other common conditions including, but not limited to, inflammatory diseases, malignancy, pregnancy, surgery, trauma, and advanced age. Bick, md the clinical approach to deep vein thrombosis dvt is based on a thorough understanding of the pathophysiology of the thrombotic process, the basis for the various diagnostic studies used to confirm a suspected diagnosis, and the. The author discuss his results in 185 outpatients with a discussion about. Background compression ultrasonography cus is the firstline imaging test in the diagnostic management of suspected deep vein thrombosis dvt of the lower extremity. But about half the time, this blood clot in a deep vein, often in your leg, causes no symptoms. Links to movies, ppt slideshows and any other multimedia files are not page 1 of 38. Deep vein thrombosis, commonly referred to as dvt, occurs when a blood clot or thrombus, develops in the large veins. Which conditions should be included in the differential. Differential diagnosis of deep venous thrombosis request pdf.
Most commonly seen in the lower extremities can be obstructive or nonobstructive. The differential diagnoses of acute appendicitis wound infection. The clinical diagnosis of deep vein thrombosis of the lower limb is unreliable. We report a case of 68yearold male presenting with headache, left side weakness, and alteration of consciousness at admission. It occurs in a wide variety of malignancies, most frequently in renal cell carcinoma rcc, wilms tumor, adrenal cortical carcinoma acc, and. Differential diagnosis sports injuries medial tibial stress. Retropharyngeal pseudoabscess from bilateral internal. This signs and symptoms information for deep vein thrombosis has been gathered from various sources, may not be fully accurate, and may not be the full list of deep vein thrombosis signs or deep vein thrombosis symptoms. This chapter describes the diagnosis of deep vein thrombosis dvt. Auckland regional clinical pathway for deep vein thrombosis differential diagnosis symptomssigns of dvt. Since pe can be fatal in certain circumstances, early diagnosis of dvt and subsequent adequate treatment with anticoagulants is of great clinical significance. Pdf deep vein thrombosis dvt is the formation of blood clots thrombi in the deep veins. Differential diagnosis of arterial constriction following an arterial rupture is dif. The risk can be reduced by keeping the hematocrit, which is the ratio of red blood cells to the amount of total blood, below 45%.
These clots usually develop in the lower leg, thigh, or pelvis, but can also occur in other large veins in the body. Upper extremity deep vein thrombosis all causes represents 1 to 4 percent of all cases of deep vein thrombosis. Radiologic diagnosis of cerebral venous thrombosis and its. Deep femoral vein drains the muscles of the thighs and it is located more laterally and deeper than the superficial femoral vein. Differential diagnoses for limb dvt include cellulitis, lymphoedema, chronic.
In serious cases, this event may result in functional impairment, loss of the lower limb, and death by renal failure. Most cases of deep vein thrombosis dvt are found in lower limbs, exposing patients to the risk of pulmonary embolism. Deep vein thrombosis, pulmonary embolism, ddimer, ageadjusted ddimer, compression ultrasonography, computed tomography pul. We present a case of extensive deep vein thrombosis treated using fondaparinux and edoxaban.
Simplified diagnostic management of suspected pulmonary. Some dvts may cause no pain, whereas others can be quite painful. The causes of internal jugular vein thrombosis are numerous, but are similar to causes of thrombosis in other sites. An evidencebased approach to differential diagnosis new york, ny. In all cases, diagnosis of deep vein thrombosis was made objectively within 48 h after admission by a combination of continuous wave doppler and b. Deep venous thrombosis dvt is a manifestation of venous thromboembolism vte.
The spectrum of disease ranges from clinically unsuspected to. While a traditional radiology dvt study uses both color and spectral doppler in addition to compression duplex or triplex exam, pointof. Deep vein thrombosis wikipedia, the free encyclopedia deep vein thrombosis, or deep venous thrombosis, dvt is the formation of a blood clot thrombus within a deep vein, a predominantly in the legs. Deep vein thrombosis nursing care management and study guide. It depends on the doctor and the type of blood clot the patient has. Diagnosis and management of acute deep vein thrombosis. Diagnostic accuracy of three ultrasonography strategies. Venous thromboembolism manifests as deep venous thrombosis dvt or pulmonary embolism, and has a mortal ity rate of 6 to 12 percent. Deep vein thrombosis dvt0 causes, symptoms, diagnosis a. Differential diagnosis underlying lung disease pulmonary fibrosis, chronic interstitial.
Deep vein thrombosis dvt is characterized by pain and swelling of the limb, which are not specific symptoms. Distinguishing between arterial and venous disease kathleen a. Not infrequently a range of pathologies are diagnosed after excluding a thrombosis, often after a period of anticoagulation. Prevention information for deep vein thrombosis has been compiled from various data sources and may be inaccurate or incomplete. The spectrum of disease ranges from clinically unsuspected to clinically unimportant to massive embolism causing death. Nov 15, 2017 deep vein thrombosis is a blood clot that forms inside a vein, usually deep within your leg. Duplex is actually gold standard for the diagnosis of the deep venous thrombosis and also for differential diagnosis.
Unilateral leg swelling is a common clinical presentation, with deep vein thrombosis dvt often the top differential. Cerebral venous thrombosis cvt is a disease with a wide spectrum of symptoms and severity. It commonly affects the deep leg veins such as the calf veins, femoral vein, or popliteal vein or the deep veins of the pelvis. Deep vein thrombosis and pulmonary embolism hpi, signs and symptoms dvt. Deep vein thrombosis treatment consists of three phases figure3. Deep vein thrombosis the classical presentation of deep vein thrombosis dvt is sudden onset of pain, redness, and swelling of one leg spreading from the calf to the thigh with marked swelling of the dorsum of the foot and tenderness along the deep venous system. Deep vein thrombosis dvt is the development of a blood clot in a major deep vein in the leg, thigh, pelvis, or abdomen, which may result in impaired venous blood flow and consequent leg swelling and pain. Deep vein thrombosis symptoms, diagnosis and treatment. Preventing hospitalassociated venous thromboembolism. This is a report of three patients who presented with a painful swollen leg and were initially treated as a deep vein thrombosis or a bakers cyst, but later diagnosed as a pleomorphic. The patient in case 1 had tenderness of the leg with a fever.
Your doctor will ask about your health, medical history, and symptoms, and they ll examine you. Diagnosis and management of deep vein thrombosis of the upper extremity. With prompt diagnosis and treatment, the majority of dvts are not life threatening. Pain on leg deep vein palpation unilateral leg pain haemoptysis low intermediate high points 1. Deep venous thrombosisdiferential diagnosis 5 5 diagnosis of dvt is based on clinical and echo doppler findings.
A thrombus either arises spontaneously or is caused by clinical. The full differential diagnosis should be considered in possible cases of dvt including bakers cyst, cellulitis, lymphedema, chronic venous insufficiency, superficial thrombophlebitis, popliteal venous or arterial aneurysm, enlarged lymph nodes compressing the veins, heterotopic ossification, hematoma, and muscle tears. Apr 29, 2011 deep vein thrombosis dvt is the formation of blood clots thrombi in the deep veins. Diagnosis of deep vein thrombosis dvt requires a multifaceted approach that includes. Deep vein thrombosis and pulmonary embolism, collectively referred to as venous thromboembolism, constitute a major global burden of disease. The diagnosis of deep vein thrombosis dvt using compression ultrasound, at the pointofcare, by the treating physician is gaining acceptance, as the literature supports its diagnostic accuracy to be similar to that of exams performed by radiologists. A quantitative deficiency of the hemoglobin, often accompanied by a reduced number of red blood cells and causing pallor, weakness, and. Jun 12, 2019 the process of diagnosis of deep vein thrombosis can be varied ways. Although rapid diagnosis and treatment are critical in preventing pe, mortality and major morbidity due to conditions such as postthrombotic syndrome may complicate the differential diagnosis of vte. Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. General practitioner performed compression ultrasonography.
This simplified clinical decision rule was combined with variable ddimer threshold depending on. Parenteral anticoagulation using low molecular weight heparin or fondaparinux is the recommended form of treatment for most patients presenting with venous thrombosis. Deep vein thrombosis dvt statpearls ncbi bookshelf. Pitfalls of differential diagnosis deep vein thrombosis or. This study also relied on hospitalbased diagnoses and was oriented to symptomatic dvt, so it cannot be called a true population survey. Deep vein thrombosis without pulmonary embolism symptoms. Diagnosis, investigation, and management of deep vein thrombosis. The diagnosis of deep vein thrombosis of leg is very common in clinical practice. Deep vein thrombosis dvt refers to the formation of a thrombus, which is a blood clot, in a deep vein. Epidemiology, pathogenesis, and diagnosis view in chinese. He was diagnosed as deep cerebral venous thrombosis dcvt of the vein of galen on the basis of brain magnetic resonance imaging mri findings. Which conditions should be included in the differential diagnoses of venous thromboembolism vte. She had been hospitalized for pneumonia one week earlier. Few of the methods for diagnosing dvt include ultrasound, blood tests, venography, ct and mri.
The goals of successful management of deep vein thrombosis dvt include relief of acute symptoms with restoration of venous patency, prevention of clot propagation and subsequent pulmonary. Although most dvt is occult and resolves spontaneously without complication, death from dvtassociated massive pulmonary embolism pe causes as many as 300,000 deaths annually in the united states. However, their relative diagnostic accuracy is uncertain. Deep vein thrombosis dvt symptoms, diagnosis, and tests. Lower extremity deep venous thrombosis dvt and pulmonary embolism pe are two manifestations of venous thromboembolism vte. Differential diagnosis of patient with thrombosis of central veins should. The patient in case 2 had erythema and warmth of the leg. Deep vein thrombosis can cause leg pain or swelling, but may occur without any symptoms. Following are differential diagnoses of deep venous thrombosis.
The value of rapid ddimer testing combined with structured clinical evaluation for the diagnosis of deep vein thrombosis. Furthermore, signs and symptoms of deep vein thrombosis may vary on an individual basis for each patient. There are other conditions that can mimic dvt such as muscle strain or muscle tear, immobilization that led to leg swelling, lymphedema, lymphangitis, chronic venous insufficiency, or cellulitis. Deep vein thrombosis and its sequelae pulmonary embolism and postthrombotic syndrome are some of the most common disorders. Differential diagnosis of deep vein thrombosis youtube. A common differential diagnosis of dvt is the presence of rouleaux formation that is an accumulation of erythrocytes lying over the venous valves represented by spontaneously echogenic blood flow inside the vessel fig. Deep vein thrombosis symptoms, diagnosis, treatments and. Auckland regional clinical pathway for deep vein thrombosis. However, many patients have no history of a provocation, and these patients are classified as ha. Deep vein thrombosis differentials bmj best practice.
All files coded as cellulitis of the leg were retrieved from the database of our vascular laboratory and were screened for an association with deep vein thrombosis. Its presence changes stage, prognosis, and treatment. The goal of treatment for polycythemia vera is to decrease the risk for developing deep vein thrombosis. Polycythemia vera genetic and rare diseases information. It presents a brief overview of the currently available technologies that continue to evolve and improve. The disorder commonly manifests as deep vein thrombosis of the leg, but deep venous thrombosis may also occur in other veins cerebral sinus, arms, retina, and mesentery. Deep vein thrombosis can have the same symptoms as many other health problems. The ultrasound diagnosis of deep venous thrombosis by an emergency physician is occurring with increased frequency. Abstractthrombosis of the deep cerebral venous system is a rare entity. Deep vein thrombosis differential diagnosis wikidoc. Confirmation is necessary before subjecting patients to the risk of longterm anticoagulation. Combination of a clinical risk assessment score and rapid whole blood ddimer testing in the diagnosis of deep vein thrombosis in symptomatic patients. Diagnostic assessment of deep vein thrombosis and pulmonary.
When the patient initially presents with pain and swelling that are similar to deep vein thrombosis, a differential diagnosis between the two diseases is very critical. Duplex doppler compression ultrasound is the current study of choice for the diagnosis of suspected dvt. Given the risks associated with untreated lower extremity dvt eg, fatal pulmonary emboli and the risk of anticoagulation eg, lifethreatening bleeding, accurate diagnosis of dvt is essential. Diagnosis of deep venous thrombosis at the pointofcare. In our case, the athlete presented on one occasion with upper.
Thromboembolism encompasses two interrelated conditions that are part of the same spectrum, deep venous thrombosis dvt and pulmonary embolism pe see the image below. Three cus strategies are used in clinical practice. Intravascular tumor thrombus is defined as tumor extension into a vessel. Venous thromboembolism vte, comprising deep vein thrombosis and pulmonary embolism pe, is the third commonest vascular disorder in caucasian populations. In the socalled subclavian vein effortinduced thrombosis pagetschroetter syndrome, patients without underlying coagulopathies have presented with thrombosis of upper extremity veins with exercise. The examination is simple to perform and, when combined with a clinical pretest. Deep vein thrombosis occurs when a blood clot thrombus forms in one or more of the deep veins in the body, usually in the legs. Diagnosis, investigation, and management of deep vein. We evaluated consecutive patients admitted with suspected cvt receiving noninvasive imaging. Patients who develop deep vein thrombosis dvt commonly have thromboembolic risk factors, such as cancer, trauma, major surgery, hospitalisation, immobilisation, pregnancy, or oral contraceptive use. Recent serious injury such as a broken bone recent surgery sitting or lying down for long periods of time having active cancer am i at risk for deep vein thrombosis dvt. Deep vein thrombosis and pulmonary embolism the lancet.
Stuerzebecher a1, machold b2, prasa d1 1poisons information centre erfurt, germany. Methods our study, practicus general practitionerperformed compression ultrasonography in the diagnosis of proximal symptomatic deep vein thrombosis of the lower limbs, was conducted in 18 primary care. Sep 24, 2017 deep vein thrombosis is a part of a condition called venous thromboembolism. To describe the clinical background, the imaging modalities that may be employed, treatment options and outcome of patients with upper extremity thrombosis. Deep vein thrombosis, venous doppler, differential diagnosis of dvt. Preventing hospitalassociated venous thromboembolism a guide for effective quality improvement prepared for. Deep vein thrombosis dvt occurs when an abnormal blood clot forms in a large vein. Oct 15, 2019 thromboembolism encompasses two interrelated conditions that are part of the same spectrum, deep venous thrombosis dvt and pulmonary embolism pe see the image below. The sequelae of deep vein thrombosis vary from complete resolution of the clot without any ill effects through to death due to pulmonary embolism. When the us is performed from above, the deep femoral vein is located in the upper portion of the deep femoral artery. The clinical diagnosis of deep vein thrombosis dvt is notoriously unreliable. Department of health and human services 540 gaither road rockville, md 20850.
In this study we analysed the predictive value of clinical signs and symptoms and the contribution of ddimer measurements for diagnosis. Diagnosis of deep venous thrombosis and pulmonary embolism. Thrombosis is the formation of a stationary blood clot along the wall of a blood vessel, which frequently causes vascular obstruction, and which can involve multiple blood vessels. Jul 28, 2015 deep vein thrombosis wikipedia, the free encyclopedia deep vein thrombosis, or deep venous thrombosis, dvt is the formation of a blood clot thrombus within a deep vein, a predominantly in the legs. Venous thromboembolism vte, which includes dvt and pulmonary embolism pe, affects an estimated 1 per 1,000 people and contributes to 60,000100,000 deaths annually. Deep vein thrombosis dvt international emergency medicine. Unilateral leg swelling redness of leg pain and tenderness warm heavy feeling. Wellvalidated clinical prediction rules are available to. If you develop dvt and it is diagnosed correctly and quickly, it can be treated. Clinical presentation varies and it depends on the severity of the thrombosis extension, partial or total occlusion, presence of collateral vessels, thrombosis location supra or infrapatellar. Clinical signs and symptoms are highly variable and unspecific but re main the. The differential diagnosis of deep vein thrombosis to consider when applying for a doppler ultrasound of the. Diseases linked by endothelial injury leading to aggregation of platelets on the damaged endothelium, microvascular thrombosis and organ dysfunction related to microvascular injury.
Deep vein thrombosis the rational clinical examination. It is a potentially dangerous condition that can lead to preventable morbidity and mortality. Following the acute phase, edoxaban is recommended. Endovascular management of acute deep vein thrombosis. Venous thrombo embolism vte deep vein thrombosis and pulmonary embolism are different manifestations of the same disease. Deep vein thrombosis dvt this causes pain and swelling in one leg without any redness. The differential diagnosis of deep vein thrombosis to. Pitfalls of differential diagnosis deep vein thrombosis or snake bite. Diagnosis of deep vein thrombosis australian prescriber. Ascending venography was the reference standard for the diagnosis of dvt, but it is invasive and associated with adverse effects.
1174 1532 1139 1590 1211 290 190 739 961 198 695 203 1112 744 1201 1436 51 966 800 170 1133 101 666 713 379 844 785 526 714 1230 170 1633 1087 87 638 419 1452 723 1073 934 788 489