Deep vein thrombosis differential diagnosis: Difference between revisions
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| [[Deep vein thrombosis resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']] | | [[Deep vein thrombosis resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']] | ||
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! Diseases | ! rowspan="2" | Diseases | ||
! colspan="7" |Symptoms | ! colspan="7" |Symptoms | ||
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! rowspan="2" | Gold standard Investigation to diagnose | ! rowspan="2" | Gold standard Investigation to diagnose | ||
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!History | !History | ||
!Onset | !Onset | ||
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!Symptoms of primary disease | !Symptoms of primary disease | ||
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!Acute deep venous thrombosis | |||
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* History of prolonged recumbency | * History of prolonged recumbency | ||
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! [[Lymphatic filariasis]] | |||
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! [[Chronic venous insufficiency]] | |||
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* [[Duplex ultrasound]] will demonstrate typical findings of [[Venous insufficiency|venous valvular insufficiency]] | * [[Duplex ultrasound]] will demonstrate typical findings of [[Venous insufficiency|venous valvular insufficiency]] | ||
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![[Lipedema]] | |||
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* Family history especially in women; [[X-linked dominant]] or [[autosomal dominant]] condition.<ref name="pmid20358611">{{cite journal| author=Child AH, Gordon KD, Sharpe P, Brice G, Ostergaard P, Jeffery S et al.| title=Lipedema: an inherited condition. | journal=Am J Med Genet A | year= 2010 | volume= 152A | issue= 4 | pages= 970-6 | pmid=20358611 | doi=10.1002/ajmg.a.33313 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20358611 }}</ref> | * Family history especially in women; [[X-linked dominant]] or [[autosomal dominant]] condition.<ref name="pmid20358611">{{cite journal| author=Child AH, Gordon KD, Sharpe P, Brice G, Ostergaard P, Jeffery S et al.| title=Lipedema: an inherited condition. | journal=Am J Med Genet A | year= 2010 | volume= 152A | issue= 4 | pages= 970-6 | pmid=20358611 | doi=10.1002/ajmg.a.33313 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20358611 }}</ref> | ||
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* MRI offers strong qualitative and quantitative parameters in the diagnosis of [[lipedema]] <ref name="pmid9412843">{{cite journal| author=Dimakakos PB, Stefanopoulos T, Antoniades P, Antoniou A, Gouliamos A, Rizos D| title=MRI and ultrasonographic findings in the investigation of lymphedema and lipedema. | journal=Int Surg | year= 1997 | volume= 82 | issue= 4 | pages= 411-6 | pmid=9412843 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9412843 }}</ref> | * MRI offers strong qualitative and quantitative parameters in the diagnosis of [[lipedema]] <ref name="pmid9412843">{{cite journal| author=Dimakakos PB, Stefanopoulos T, Antoniades P, Antoniou A, Gouliamos A, Rizos D| title=MRI and ultrasonographic findings in the investigation of lymphedema and lipedema. | journal=Int Surg | year= 1997 | volume= 82 | issue= 4 | pages= 411-6 | pmid=9412843 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9412843 }}</ref> | ||
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![[Myxedema]] | |||
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* History of untreated [[hypothyroidism]]. | * History of untreated [[hypothyroidism]]. | ||
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* [[Thyroid function tests|Thyroid function tests.]] | * [[Thyroid function tests|Thyroid function tests.]] | ||
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!([[Cellulitis]]-[[Erysipelas|erysipelas-]]<nowiki/>[[skin abscess]]) | |||
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* Acute painful [[swelling]] | * Acute painful [[swelling]] | ||
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* In patients with recurrent [[cellulitis]], serologic ''testing for [[beta-hemolytic streptococci]]'' is a good diagnostic tool''.''<ref name="pmid4005155">{{cite journal| author=Leppard BJ, Seal DV, Colman G, Hallas G| title=The value of bacteriology and serology in the diagnosis of cellulitis and erysipelas. | journal=Br J Dermatol | year= 1985 | volume= 112 | issue= 5 | pages= 559-67 | pmid=4005155 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4005155 }}</ref> | * In patients with recurrent [[cellulitis]], serologic ''testing for [[beta-hemolytic streptococci]]'' is a good diagnostic tool''.''<ref name="pmid4005155">{{cite journal| author=Leppard BJ, Seal DV, Colman G, Hallas G| title=The value of bacteriology and serology in the diagnosis of cellulitis and erysipelas. | journal=Br J Dermatol | year= 1985 | volume= 112 | issue= 5 | pages= 559-67 | pmid=4005155 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4005155 }}</ref> | ||
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!Other causes of [[generalized edema]] | |||
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* History of chronic general condition (cardiac-liver-renal) | * History of chronic general condition (cardiac-liver-renal) | ||
Latest revision as of 16:53, 7 March 2018
<figure-inline><figure-inline> </figure-inline></figure-inline> |
Resident Survival Guide |
Editor(s)-In-Chief: The APEX Trial Investigators, C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2] Kashish Goel, M.D.; Assistant Editor(s)-In-Chief: Justine Cadet
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Deep vein thrombosis differential diagnosis On the Web |
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Risk calculators and risk factors for Deep vein thrombosis differential diagnosis |
Overview
Deep vein thrombosis DVT is characterized by pain and swelling of the limb, which are not specific symptoms. There are other conditions that can mimic DVT such as muscle strain or muscle tear, immobilization that led to leg swelling, lymphedema, lymphangitis, chronic venous insufficiency, or cellulitis.
Differential Diagnosis
Deep vein thrombosis must be differentiated from other causes of lower limb edema like chronic venous insufficiency, lymphatic filariasis, lipedema, myxedema, cellulitis and causes of generalized edema.
| Diseases | Symptoms | Signs | Gold standard Investigation to diagnose | ||||||
|---|---|---|---|---|---|---|---|---|---|
| History | Onset | Pain | Fever | Laterality | Scrotal swelling | Symptoms of primary disease | |||
| Acute deep venous thrombosis | Acute | + | - | Unilateral | - | May be associated with primary disease mandates recumbency for long duration |
|
| |
| Lymphatic filariasis |
|
Chronic | + | + | Bilateral | + | - |
|
Preparing blood smears
By the ultrasound, the following findings can be observed:
|
| Chronic venous insufficiency |
|
Chronic | + | - | Bilateral | +
(If congenial) |
- |
| |
| Lipedema |
|
Chronic | + | - | Bilateral | - | - |
|
|
| Myxedema |
|
Chronic | + | - | Bilateral | - | + | ||
| (Cellulitis-erysipelas-skin abscess) | Acute | + | + | Unilateral | - | - |
|
| |
| Other causes of generalized edema |
|
Chronic | - | - | Bilateral | - | + |
| |
Shown below is a list of conditions that can mimic DVT.
- Venous
- Superficial thrombophlebitis
- Post-thrombotic syndrome
- Chronic venous insufficiency
- Venous obstruction
- Other
- Cellulitis
- Torn gastrocnemius muscle
- Fracture
- Hematoma
- Acute arterial ischaemia
- Lymphoedema
- Hypoproteinemia (for example, cirrhosis, nephrotic syndrome)
- Muscle tear or leg strain
- Leg swelling in a paralyzed limb
- Lymphangitis or lymph obstruction
- Popliteal/Baker's cyst
- Cellulitis
- Knee abnormality
References
- ↑ Goodacre S, Sutton AJ, Sampson FC (2005). "Meta-analysis: The value of clinical assessment in the diagnosis of deep venous thrombosis". Ann Intern Med. 143 (2): 129–39. PMID 16027455. Review in: ACP J Club. 2006 Mar-Apr;144(2):46-7 Review in: Evid Based Med. 2006 Apr;11(2):56
- ↑ Child AH, Gordon KD, Sharpe P, Brice G, Ostergaard P, Jeffery S; et al. (2010). "Lipedema: an inherited condition". Am J Med Genet A. 152A (4): 970–6. doi:10.1002/ajmg.a.33313. PMID 20358611.
- ↑ Trayes KP, Studdiford JS, Pickle S, Tully AS (2013). "Edema: diagnosis and management". Am Fam Physician. 88 (2): 102–10. PMID 23939641.
- ↑ Dimakakos PB, Stefanopoulos T, Antoniades P, Antoniou A, Gouliamos A, Rizos D (1997). "MRI and ultrasonographic findings in the investigation of lymphedema and lipedema". Int Surg. 82 (4): 411–6. PMID 9412843.
- ↑ Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJ, Gorbach SL; et al. (2014). "Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases society of America". Clin Infect Dis. 59 (2): 147–59. doi:10.1093/cid/ciu296. PMID 24947530.
- ↑ Raff AB, Kroshinsky D (2016). "Cellulitis: A Review". JAMA. 316 (3): 325–37. doi:10.1001/jama.2016.8825. PMID 27434444.
- ↑ Woo PC, Lum PN, Wong SS, Cheng VC, Yuen KY (2000). "Cellulitis complicating lymphoedema". Eur J Clin Microbiol Infect Dis. 19 (4): 294–7. PMID 10834819.
- ↑ Leppard BJ, Seal DV, Colman G, Hallas G (1985). "The value of bacteriology and serology in the diagnosis of cellulitis and erysipelas". Br J Dermatol. 112 (5): 559–67. PMID 4005155.