0071643192.pdf

SYMPTOMS/EXAM

■ Symptoms and physical examination are often nonspecific.
■ Unilateral limb swelling, pain
■ Tender palpable cord
■ Erythema and warmth
■ Distended collateral veins
■ Homan’s sign (pain in calf or posterior knee with passive dorsiflexion of
foot) is unreliable.
■ Phlegmasia cerulean dolens (painful blue leg)= massive iliofemoral
thrombosis causing acute, massive edema, severe pain, and cyanosis.
■ Phlegmasia alba dolens (painful white leg)=massive iliofemoral throm-
bosis causing arterial spasm and a swollen, pale leg.

DIFFERENTIAL

■ Superficial thrombophlebitis
■ Cellulitis
■ Lymphedema
■ Musculoskeletal injury
■ Baker’s cyst

DIAGNOSIS

■ The diagnosis should be considered in allpatients presenting with symp-
toms/exam that raise concerns for DVT, especially in presence of risk
factors.

Risk Stratification

■ Well’s criteria (see Table 2.28)
■ Initial step in establishing diagnosis
■ Estimates the pretest likelihood of DVT
■ Score<2 indicates a low or moderate pretest riskfor DVT.

CARDIOVASCULAR EMERGENCIES

Phlegmasia cerulean dolens

(painful blue leg) =massive

thrombosis with venous

insufficiency.

Phlegmasia alba dolens

(painful white leg) =massive

thrombosis with arterial

spasm.

TABLE 2.28. Well’s Pretest Probability for Predicting DVT

CRITERIA SCORE

Active cancer 1

Paralysis/immobilization 1

Bedridden 3 days/surgery in last 12 weeks 1

Tender along deep vein (localized) 1

Entire leg swollen 1

Unilateral calf swelling (>3 cm) 1

Pitting edema, 1 leg 1

Collateral superficial nonvaricose vein 1

Previous documented DVT 1

Alternative diagnosis likely − 2

Score< 2 =low or moderate risk for DVT

Score>− 2 =high risk for DVT