DVT (Deep Venous Thrombosis) - Diagnosis

Clinical signs
  • Clinical signs are unreliable but should not be ignored
  • Calf tenderness, swelling, fever, and increased pulse rate may be present
Work up for DVT
Ultrasound

MRI
  • may emerge as the new gold standard for diagnosis of DVT
  • can diagnosis pelvic DVT, and can be used to diagnose DVT in patients who have femoral or tibial frx
Impedence phlebography
  • inaccurate
  • difficult to perform
Venography
  • remains the gold standard for diagnosis of DVT
  • venograms should meet at least one of the following direct or indirect criteria
    • a constant defect in filling seen on two views
    • an abrupt discontinuation of visible filling at a constant site in the vein
    • the absence of filling in the entire deep-vein system (without external compression), w/ or w/o venous flow through collaterals
  • disadvantages
    • some have questioned whether venography might actually cause DVT to form due to vessel inflammation from the contrast dye (estimated that 1-3% of venograms lead to DVT); this complication is now less common with newer contrast dye
    • systemic reactions
    • skin necrosis from extravasation from dye
    • inability to diagnose pelvic venous thrombi
    • cannot be used when there is ipsilateral femoral or tibial frx
References

Comparison of enoxaparin and warfarin for the prevention of venous thromboembolic disease after total hip arthroplasty. Evaluation during hospitalization and three months after discharge

Finding the right fit: effective thrombosis risk stratification in orthopaedic patients.

See also
Coagulation Pathway
Pulmonary Embolus



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Monday, February 17, 2014 3:12 pm