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| __NOTOC__
| | #Redirect [[Deep vein thrombosis special scenario pregnancy]] |
| '''Editor(s)-In-Chief:''' {{ATI}}, [[C. Michael Gibson, M.S., M.D.]] [mailto:mgibson@perfuse.org]; '''Associate Editor(s)-In-Chief:''' {{CZ}} ; [[User:Kashish Goel|Kashish Goel, M.D.]]; '''Assistant Editor(s)-In-Chief:''' [[User:Justine Cadet|Justine Cadet]]
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| {{Deep vein thrombosis}}
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| ==Overview==
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| The approach to diagnosis of [[DVT]] may be modified in certain situations, where the suspicion is high or there is a recurrent episode. This chapter will discuss these modifications that have been recommended to the American College of Chest Physicians.<ref name="pmid22315267">{{cite journal |author=Bates SM, Jaeschke R, Stevens SM, ''et al.'' |title=Diagnosis of DVT: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines |journal=Chest |volume=141 |issue=2 Suppl |pages=e351S–418S |year=2012 |month=February |pmid=22315267 |doi=10.1378/chest.11-2299 |url=}}</ref>
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| ==Recurrent DVT==
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| * Patients suspected to have a recurrent episode of [[DVT]] may benefit from [[thrombophilia]] evaluation.
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| * Initial test in these patients should be a [[Deep vein thrombosis ultrasound|compression ultrasound]] if a previous ultrasound is available for comparison. A highly-sensitive [[Deep vein thrombosis D-dimer|D-dimer]] is also a possible test.
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| * If the [[Deep vein thrombosis ultrasound|compression ultrasound]] results are abnormal but nondiagnostic (increase in residual venous diameter of < 4 but ≥ 2 mm), further testing with [[Deep vein thrombosis venography|venography]] or [[Deep vein thrombosis CT venography|CT venography]] may be indicated.
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| ==Pregnant Patients==
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| * Initial test should be a proximal [[Deep vein thrombosis ultrasound|compression ultrasound]].
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| * If the initial proximal [[Deep vein thrombosis ultrasound|compression ultrasound]] is negative, serial testing with either proximal [[Deep vein thrombosis ultrasound|compression ultrasound]] at day 3 and day 7 or a D-dimer at presentation should be done.
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| * Doppler ultrasound of the [[iliac]] vein is recommended if there are signs of isolated iliac vein thrombosis like swelling of the entire leg, with or without flank, buttock, or back pain.
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| ==Upper Extremity [[DVT]]==
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| * Combined modality ultrasound ([[Deep vein thrombosis ultrasound|compression ultrasound]] with either Doppler to color Doppler) is the initial test of choice.
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| * If the initial ultrasound is negative, but clinical suspicion stays high, further testing with [[serial ultrasound]], [[D-dimer]], or [[venography]] should be performed.
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| ==[[CUS]] as the first initial test==
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| It is recommended that [[Deep vein thrombosis pretest probabiltiy|pretest probability]] should be computed in each patient to assess the need for further testing. However in certain clinical scenarios (like moderate probability), the clinician may decide to proceed with [[Deep vein thrombosis ultrasound|compression ultrasound]] as the first test.
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| * If positive, then treatment should be started.
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| * If negative, repeat [[Deep vein thrombosis ultrasound|compression ultrasound]] or D-dimer testing should be done in 1 week.
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| ==Positive D-dimer only==
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| * If the initial D-dimer is positive, but [[Deep vein thrombosis ultrasound|compression ultrasound]] is negative, a repeat [[Deep vein thrombosis ultrasound|compression ultrasound]] should be performed in 1 week.
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| ==Isolated distal [[DVT]]==
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| * On identification of an isolated [[DVT]] in the distal calf veins, serial testing is recommended to rule out proximal extension.
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| ==References==
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| {{reflist|2}}
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| [[Category:Hematology]]
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| [[Category:Pulmonology]]
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| [[Category:Cardiology]]
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| [[Category:Emergency medicine]]
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| [[Category:Mature chapter]]
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| {{WH}}
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| {{WS}}
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