Clinical Case Database / Category: Patient Management

Diagnosis of deep vein thrombosis in the leg

Publication details

Jessamy Bagenal, Kapil Sahnan, Saran Shantikumar, Ashok Handa
Foundation Years Journal, volume 5, issue 1, p.42 (123Doc Education, London, February 2011)

Abstract

In this article, we discuss the clinical presentation and the current accepted method of diagnosis of deep vein thrombosis. Furthermore, we assess the different forms of imaging available and their relative advantages in diagnosing unusual manifestations of DVT.

Access the Clinical Cases Database

A subscription is required to read the full article. Please subscribe using one of the options below.

ProductPriceSubscription
Foundation Years Clinical Cases Database£29.006 months
Add to cart
Foundation Years Clinical Cases Database£39.0012 months
Add to cart

Authors

Jessamy Bagenal

Foundation Year 2, Department of General Surgery
Stoke Mandeville Hospital
Aylesbury
HP21 8AL

Kapil Sahnan

Foundation Year 2
Department of Cardiothoracic Surgery
John Radcliffe Hospital
Oxford
OX3 9DU

Saran Shantikumar

Academic Clinical Fellow
Nuffield Department of Surgery
John Radcliffe Hospital
Oxford
OX3 9DU

Ashok Handa

Consultant Vascular Surgeon, Clinical
Tutor and Reader in Surgery
Nuffield Department of Surgical Sciences
John Radcliffe Hospital
Oxford
OX3 9DU

References

1. White RH. The epidemiology of venous thromboembolism. Circulation. 2003;107 (23suppl 1):14-18.
2. House of Commons Health Committee. The prevention of venous thromboembolism in hospitalised patients. London: the Stationary Office 2005.
3. NHS direct www.nhsdirect.nhs.uk
4. Tan M, Van Rooden CJ, Westerbeek RE, Huisman MV. Diagnostic management of clinically suspected acute deep vein thrombosis. Br J Haemat 2009; 149: 631.
5. Schulman S, Beyth RJ, Kearon C, Levine MN. Hemorrhagic complications of anticoagulant and thrombolytic treatment: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008;133:257Sâ€"298S.
6. Attia J, Ray JG, Cook DJ, Douketis J, Ginsberg JS, Geerts W. Prophylaxis of venous thromboembolism in the critically ill. Arch Intern Med 2001;161:1268-1279.
7. Goodacre S, Sutton AJ, Sampson FC. Meta-analysis: the value of clinical assessment in the diagnosis of deep venous thrombosis. Annals of Internal Medicine 2005;143: 129â€"139.
8. Kahn SR, Joseph L, Abenhaim L, Leclerc JR. Clinical prediction of deep vein thrombosis in patients with leg symptoms. Thromb Haemost 1999;81: 353â€"357.
9. Constans J, Nelzy ML, Salmi LR et al. Clinical prediction of lower limb deep vein thrombosis in symptomatic hospitalized patients. Thrombosis and Haemostasis 2001;86: 985â€"990.
10. Constans J, Boutinet C, Salmi LR, Saby JC, Nelzy ML, Baudouin P et al. Comparison of four clinical prediction scores for the diagnosis of lower limb deep venous thrombosis in outpatients. American Journal of Medicine 2003;115:436â€"440.
11. Righini M, Perrier A, De Moerloose P, Bounameaux, H. D-dimer for venous thromboembolism diagnosis: 20 years later. J Thromb Haemost 2008;6:1059â€"1071.
12. Di Nisio M, Squizzato A, Rutjes AW, Büller HR, Zwinderman AH,Bossuyt PM. Diagnostic accuracy of D-dimer test for exclusion of venous thromboembolism: a systematic review. J Thrombosis Haemost 2007;5:296â€"304.
13. Goodacre S, Sampson, FC, Sutton AJ, Mason S, Morris F. Variation in the diagnostic performance of D-dimer for suspected deep vein thrombosis. QJM 2005;98: 513â€"527.
14. Dempfle CE, Korte W, Schwab M, Zerback R, Huisman, MV. Sensitivity and specificity of a quantitative point of care D-dimer assay using heparinized whole blood in patients with clinically suspected deep vein thrombosis. Thromb Haemost 2006;96: 79â€"83.
15. Kearon C, Julian JA, Newman TE, Ginsberg JS. Noninvasive diagnosis of deep venous thrombosis. Ann Int Med 1998;28: 663â€"677.
16. Goodacre S, Sampson F, Stevenson M et al. Measurement of the clinical and cost-effectiveness of non-invasive diagnostic testing strategies for deep vein thrombosis. Health Technol Assess. 2006;10(15): 1â€"168, iiiâ€"iv.
17. Hirsh J, Lee AY. How we diagnose and treat deep vein thrombosis. Blood 2002; 99:3102-10.
18. Ten Cate-Hoek AJ, Prins MH. Management studies using a combination of D-dimer test result and clinical probability to rule out venous thromboembolism: a systematic review. Journal of Thrombosis and Haemostasis 2005;3: 2465â€"2470.
19. Rabinov K, Paulin S. Roentgen diagnosis of venous thrombosis in the leg. Arch Surg 1972;104:134â€"44.
20. Greitz T. The technique of ascending phlebography of the lower extremity. Acta Radiol 1954;42:421â€"41.
21. Thomas ML. Phlebography. Arch Surg 1972;104:145â€"51.
22. P Shidu. Lower limb contrast venography: a modified technique for use in thromboprophylaxis clinical trials for the accurate evaluation of deep vein thrombosis, Br J Radiol. 2007 Nov;80(959):859-65. Epub 2007 Oct 1.
23. Tapson VF, Carroll BA, Davidson BL, Elliott CG, Fedullo PF, Hales CA et al. The diagnostic approach to acute venous thromboembolism. Clinical practice guideline. American Thoracic Society. Am J Respir Crit Care Med 1999;160:1043â€"66.
24. Eriksson BI, Quinlan DJ. Oral anticoagulants in development: focus on thromboprophylaxis in patients undergoing orthopaedic surgery. Drugs 2006;66:1411â€"29.
25. Stevens CM, Muntean E. Venous Thromboembolism. Radiol Technol 2007;78(4):309â€"327.
26 Gaitini D. Multimodality imaging of the peripheral venous system. Int J Biomed Imaging. 20.07;2007:54616.
27. Wheeler, H.B & Anderson (1982) Impedence plethysmography. Practical Noninvasive Vascular Diagnosis, ppl277-304.Year Book Medical Publishers, New York.
28. Locker T, Goodacre S, Sampson F, Webster A, Sutton AJ. Meta-analysis of plethysmography and rheography in the diagnosis of deep vein thrombosis. Emerg Med J 2006;23(8):630â€"635.

Disclaimers

Conflict Of Interest

The Journal requires that authors disclose any potential conflict of interest that they may have. This is clearly stated in the Journal’s published “Guidelines for Authors”. The Journal follows the Guidelines against Conflict of Interest published in the Uniform Requirements for Manuscripts Submitted to Biomedical Journals (http://www.icmje.org/urm_full.pdf).

Financial Statement

The authors of this article have not been paid. The Journal is financed by subscriptions and advertising. The Journal does not receive money from any other sources. The decision to accept or refuse this article for publication was free from financial considerations and was solely the responsibility of the Editorial Panel and Editor-in-Chief.

Patient Consent statement

All pictures and investigations shown in this article are shown with the patients’ consent. We require Authors to maintain patients’ anonymity and to obtain consent to report investigations and pictures involving human subjects when anonymity may be compromised. The Journal follows the Guidelines of the Uniform Requirements for Manuscripts (http://www.icmje.org/urm_full.pdf). The Journal requires in its Guidelines for Authors a statement from Authors that “the subject gave informed consent”.

Animal & Human Rights

When reporting experiments on human subjects, the Journal requires authors to indicate whether the procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the HelsinkiDeclaration of 1975, as revised in 2008.

About the Clinical Cases Database

T​he Foundation Years Clinical Cases Database is​ a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.

The database is fully searchable, or can be browsed by medical specialty. Abstracts can be read free of charge, however a subscription is required in order to read the complete cases.