|
|
| (6 intermediate revisions by 3 users not shown) |
| Line 1: |
Line 1: |
| __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]]
| |
| | |
| {{Deep vein thrombosis}}
| |
| ==Overview==
| |
| 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>
| |
| | |
| ==Recurrent DVT==
| |
| * Patients suspected to have a recurrent episode of [[DVT]] may benefit from [[thrombophilia]] evaluation.
| |
| * 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.
| |
| * 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.
| |
| | |
| ==Pregnant Patients==
| |
| * Initial test should be a proximal [[Deep vein thrombosis ultrasound|compression ultrasound]].
| |
| * 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.
| |
| * 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.
| |
| | |
| ==Upper Extremity [[DVT]]==
| |
| * Combined modality ultrasound ([[Deep vein thrombosis ultrasound|compression ultrasound]] with either Doppler to color Doppler) is the initial test of choice.
| |
| * If the initial ultrasound is negative, but clinical suspicion stays high, further testing with [[serial ultrasound]], [[D-dimer]], or [[venography]] should be performed.
| |
| | |
| ==[[CUS]] as the First Initial Test==
| |
| It is recommended that the [[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.
| |
| * If positive, then treatment should be started.
| |
| * If negative, repeat the [[Deep vein thrombosis ultrasound|compression ultrasound]]. If not, D-dimer testing should be done in 1 week.
| |
| | |
| ==Positive D-dimer only==
| |
| * 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.
| |
| | |
| ==Isolated distal [[DVT]]==
| |
| * On identification of an isolated [[DVT]] in the distal calf veins, serial testing is recommended to rule out proximal extension.
| |
| | |
| ==References==
| |
| {{reflist|2}}
| |
| | |
| [[Category:Hematology]]
| |
| [[Category:Pulmonology]]
| |
| [[Category:Cardiology]]
| |
| [[Category:Emergency medicine]]
| |
| [[Category:Mature chapter]]
| |
| | |
| {{WH}}
| |
| {{WS}}
| |