Deep vein thrombosis history and symptoms

Editors-in-Chief: C. Michael Gibson, M.S., M.D. Associate Editor-In-Chief: Ujjwal Rastogi, MBBS [mailto:urastogi@perfuse.org]

Overview
The goal of any diagnostic strategy is to diagnose deep vein thrombosis accurately so that patients with deep vein thrombosis receive appropriate treatment and patients without deep vein thrombosis avoid the risks of prolonged anticoagulation. In 25% of all hospitalized patients, there may be some form of DVT, which often remains clinically in-apparent (unless pulmonary embolism develops). It is vital that the possibility of pulmonary embolism be included in the history, as this may warrant further investigation (see pulmonary embolism). There are several techniques during physical examination to increase the detection of DVT.

History
In patients having known risk factors, a careful history should be taken. It must include the following: A family history can reveal a hereditary factor in the development of DVT. A positive family history is in one or more first-degree relatives under age 50 suggests the presence of a hereditary defect and/or an increased susceptibility for venous thromboembolic diseases.
 * History of any recent surgical procedure.
 * Use of hormonal contraception, containing estrogen
 * Recent long-haul flying
 * History of miscarriage (which can be a feature of thrombosis and several other disorders).

Symptoms
The classical symptoms of DVT include:
 * Pain in the affected area.
 * Swelling of the affected area.
 * Dilation of the surface veins and erythema of the overlying area.

There may be no symptoms referable to the location of the DVT. .

There are several techniques during physical examination to increase the detection of DVT, such as measuring the circumference of the affected and the contra-lateral limb at a fixed point (to objective edema), and palpating the venous tract, which is often tender. Physical examination is unreliable for excluding the diagnosis of deep vein thrombosis.

In phlegmasia alba dolens, the leg is pale and cold with a diminished arterial pulse. It usually results from acute occlusion of the iliac and femoral veins due to DVT.

In phlegmasia cerulea dolens, there is an acute and near-total venous occlusion of the entire extremity outflow, including the iliac and femoral veins. The leg is usually painful, cyanosed and edematous.If not dealt properly it might form into a gangrene.