Isolated distal deep venous thrombosis

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

Only 40% of ambulatory ED patients with PE have concomitant DVT[1][2]

Clinical Features

Differential Diagnosis

Calf pain

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.