I74.9 Embolism and thrombosis of unspecified artery
I82.4 Acute embolism and thrombosis of deep veins of lower extremity
I82.90 Acute embolism and thrombosis of unspecified vein
Algorithm for diagnosis of deep venous thrombosis (DVT) in pregnancy with D-dimer as the first decision node. LMWH, low-molecular-weight heparin. (From Tintinalli JE, Stapczynski J, John Ma O, Cline D, Cydulka R, Meckler G Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 7th ed. www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)
Superficial phlebitis and deep venous thrombosis. A. A linear painful erythematous cord extending from the popliteal fossa to the mid-calf in a 35-year-old man who had moderate varicosities. Phlebitis occurred after a 15-hour flight. B. The leg is swollen, pale, with a blotchy cyanotic discoloration, and is painful. The episode occurred after abdominal surgery (the circular marks are from a compression bandage). (From Wolff K, Johnson RA. Fitzpatrick’s Color Atlas and Synopsis of Clinical Dermatology, 6th ed. www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)
PREFERRED PRACTICE PATTERN
A 42-year-old diabetic woman complains of soreness of the left leg. She is moderately obese and has been recovering from surgical removal of her gallbladder (cholecystectomy) performed 2 weeks ago. On examination, she has obvious swelling in the left lower leg and some tenderness of the calf that increases when the calf is gently squeezed. There is no redness of the leg, and she is afebrile (without fever). 4
Clot formation and acute inflammation of deep vein
Associated with Virchow’s triad:5
Most commonly occurs in lower extremity (LE)
Pulmonary embolism (PE) occurs when blood clot breaks off and settles in lung
Clinical decision rule for outpatients suspected of having a proximal deep vein thrombosis (DVT)6
History: Family history, recent trauma, cancer, oral contraceptives
Subjective report of pain
Reproduction of symptoms with dorsiflexion of the ankle (Homan’s sign) and palpation5
Diagnostic ultrasound of affected veins
Well’s score or criteria: Possible scores range from −2 to 9
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