Isolated distal deep venous thrombosis: Difference between revisions
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==Background== | ==Background== | ||
*Isolated tibial or peroneal DVTs | *Isolated tibial or peroneal DVTs | ||
*Up to 25% IDDVTs propagate in hospitalized | *Up to 25% IDDVTs propagate in hospitalized patients, but incidence is lower in ambulatory patients | ||
{{Venous thromboembolism types}} | |||
==Clinical Features== | |||
*See [[DVT]] | |||
==Differential Diagnosis== | |||
{{Calf pain DDX}} | |||
==Evaluation== | |||
*US | |||
==Management== | ==Management== | ||
*Repeat DVT scan in 2-5 days to look for clot propagation | *Repeat [[DVT]] scan in 2-5 days to look for clot propagation | ||
*May require anticoagulation for 3 months if clot extends proximally | *May require anticoagulation for 3 months if clot extends proximally | ||
==Disposition== | |||
*Case by case basis, with discharge and follow up [[ultrasound]] as reasonable option | |||
*Must weight risk of bleeding of anticoagulation with risk of clot propagation | |||
==See Also== | |||
*[[DVT]] | |||
== | ==References== | ||
*Kline JA. Pulmonary Embolism and Deep Vein Thrombosis, in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 8. St. Louis, Mosby, Inc., 2013, (Ch) 88: p 1157-1170. | *Kline JA. Pulmonary Embolism and Deep Vein Thrombosis, in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 8. St. Louis, Mosby, Inc., 2013, (Ch) 88: p 1157-1170. | ||
*Guyatt GH, Akl EA, Crowther M, Gutterman DD, Schuünemann HJ. Chest. 2012;141(2_suppl):7S-47S. doi:10.1378/chest.1412S3. | *Guyatt GH, Akl EA, Crowther M, Gutterman DD, Schuünemann HJ. Chest. 2012;141(2_suppl):7S-47S. doi:10.1378/chest.1412S3. | ||
[[Category:Cardiology]] | |||
[[Category:Vascular]] | |||
Latest revision as of 02:25, 31 October 2018
Background
- Isolated tibial or peroneal DVTs
- Up to 25% IDDVTs propagate in hospitalized patients, but incidence is lower in ambulatory patients
Clinical Spectrum of Venous thromboembolism
- Deep venous thrombosis (uncomplicated)
- Phlegmasia alba dolens
- Phlegmasia cerulea dolens
- Venous gangrene
- Pulmonary embolism
- Isolated distal deep venous thrombosis
Only 40% of ambulatory ED patients with PE have concomitant DVT[1][2]
Clinical Features
- See DVT
Differential Diagnosis
Calf pain
- Achilles tendon rupture
- Calcaneal bursitis
- Cellulitis
- Compartment syndrome
- Deep venous thrombosis (DVT)
- Distal leg fractures
- Gastrocnemius strain
- Ruptured popliteal cyst (Bakers cyst)
- Superficial thrombophlebitis
Evaluation
- US
Management
- Repeat DVT scan in 2-5 days to look for clot propagation
- May require anticoagulation for 3 months if clot extends proximally
Disposition
- Case by case basis, with discharge and follow up ultrasound as reasonable option
- Must weight risk of bleeding of anticoagulation with risk of clot propagation
See Also
References
- Kline JA. Pulmonary Embolism and Deep Vein Thrombosis, in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 8. St. Louis, Mosby, Inc., 2013, (Ch) 88: p 1157-1170.
- Guyatt GH, Akl EA, Crowther M, Gutterman DD, Schuünemann HJ. Chest. 2012;141(2_suppl):7S-47S. doi:10.1378/chest.1412S3.
- ↑ Righini M, Le GG, Aujesky D, et al. Diagnosis of pulmonary embolism by multidetector CT alone or combined with venous ultrasonography of the leg: a randomised non-inferiority trial. Lancet. 2008; 371(9621):1343-1352.
- ↑ Daniel KR, Jackson RE, Kline JA. Utility of the lower extremity venous ultrasound in the diagnosis and exclusion of pulmonary embolism in outpatients. Ann Emerg Med. 2000; 35(6):547-554.