Isolated distal deep venous thrombosis: Difference between revisions
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{{Calf pain DDX}} | {{Calf pain DDX}} | ||
== | ==Evaluation== | ||
*US | *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== | ==Disposition== | ||
*Case by case basis, with discharge and follow up | *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 | *Must weight risk of bleeding of anticoagulation with risk of clot propagation | ||
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.