Internal Medicine

0521779407-C04 CUNY1086/Karliner 0 521 77940 7 June 14, 2007 20:37

Cytomegalovirus Deep Venous Thrombosis 463

■In immunocompromised (usually profoundly immunosuppressed),

wide spectrum:

➣Asymptomatic

➣Hepatitis

➣Retinitis

➣Pneumonitis

Deep Venous Thrombosis..............................

RAJABRATA SARKAR, MD

history & physical

History

■Slow onset of leg or arm swelling, pain and edema

■Predisposing conditions

➣Leg or pelvic trauma

➣Pregnancy

➣Malignancy

➣Obesity

➣Nephrotic syndrome

➣Intravenous drug abuse

➣Oral contraceptive use

➣Indwelling venous catheters

➣History of prior deep venous thrombus (DVT)

➣Prior episode of post-operative “leg swelling” (undiagnosed prior

DVT)

➣Known hypercoagulable states

Factor V Leyden mutation

Protein C or S deficiency

Lupus anticoagulant

Antithrombin III deficiency

Hyperhomocysteinemia

Signs & Symptoms

■Swollen edematous limb with diffuse tenderness on deep palpa-

tion

■Severe edema with purple changes of skin

➣Suggestive of arterial obstruction secondary to venous obstruc-

tion

➣Can have sensory and eventually motor changes