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''' | __NOTOC__ | ||
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| [[File:Siren.gif|30px|link=Deep vein thrombosis resident survival guide]]|| <br> || <br> | |||
| [[Deep vein thrombosis resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']] | |||
|} | |||
'''Editor(s)-In-Chief:''' {{ATI}}, [[C. Michael Gibson, M.S., M.D.]] [mailto:charlesmichaelgibson@gmail.com]; '''Associate Editor(s)-In-Chief:''' {{CZ}}; [[User:Kashish Goel|Kashish Goel, M.D.]]; [[User:Justine Cadet|Justine Cadet]]; {{Rim}} | |||
{{Deep vein thrombosis}} | {{Deep vein thrombosis}} | ||
==Overview== | |||
The physical examination may be completely normal in patients with DVT. A high degree of suspicion is necessary for early identification of [[venous thrombosis]], as sometimes these patients are admitted with a different complaint and a thorough physical exam gives a clue to the diagnosis. The typical symptoms of DVT include unilateral calf or thigh [[tenderness]], [[swelling]], and/or [[erythema]]. Since DVT can be complicated by [[pulmonary embolism]] (PE), the physical exam should include assessment of the signs of [[PE]], such as [[tachypnea]] and [[tachycardia]] among others. | |||
Physical | == Physical Examination == | ||
* | === Vitals === | ||
* | * Temperature, [[blood pressure]], [[heart rate]] and [[respiratory rate]] may all be within normal range in [[DVT]]. | ||
* | * Among patients with [[DVT]] complicated by [[PE]], the following might be present: | ||
* | ** [[Blood pressure]] lower than baseline, suggestive of [[cardiogenic shock]] (associated with [[tachycardia]] and end organ hypoperfusion) | ||
**[[Tachycardia]] (26%)<ref name="pmid18757870">{{cite journal| author=Torbicki A, Perrier A, Konstantinides S, Agnelli G, Galiè N, Pruszczyk P et al.| title=Guidelines on the diagnosis and management of acute pulmonary embolism: the Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC). | journal=Eur Heart J | year= 2008 | volume= 29 | issue= 18 | pages= 2276-315 | pmid=18757870 | doi=10.1093/eurheartj/ehn310 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18757870 }} </ref> | |||
**[[Tachypnea]] (70%)<ref name="pmid18757870">{{cite journal| author=Torbicki A, Perrier A, Konstantinides S, Agnelli G, Galiè N, Pruszczyk P et al.| title=Guidelines on the diagnosis and management of acute pulmonary embolism: the Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC). | journal=Eur Heart J | year= 2008 | volume= 29 | issue= 18 | pages= 2276-315 | pmid=18757870 | doi=10.1093/eurheartj/ehn310 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18757870 }} </ref> | |||
** [[Low grade fever]] | |||
=== Extremities === | |||
One of the most significant part of the physical exam in a patient with a suspected [[DVT]] is the measurement of the size of both legs at the same point (usually measured vertically from the knee joint), to assess for differences. If a difference is detected, and there is suspicion of DVT, further tests should be conducted. The complete exam of the extremities should include the assessment of all the following: | |||
* Unilateral calf or thigh tenderness | |||
* Unilateral calf or thigh [[pitting edema]] | |||
* Unilateral calf or thigh swelling | |||
* Difference in calf diameters > 3 cm (the calf circumference is measured 10 cm below the tibial tuberosity) | |||
* Difference in thigh diameters (the thigh circumference is measured 10-15 cm above the patella) | |||
* Unilateral calf or thigh warmth | |||
* Unilateral calf or thigh [[erythema]] | |||
* Palpable cord (a thickened palpable vein suggestive of [[vein thrombosis|thrombosed vein]]) | |||
* Dilatation of unilateral collateral [[superficial veins]] | |||
* Localized tenderness upon palpation of the [[deep veins]] | |||
** Posterior calf | |||
** Popliteal fossa | |||
** Inner anterior thigh | |||
===Skin=== | |||
* Generalized [[edema]] (suggestive of [[right heart failure]], or [[nephrotic syndrome]]) | |||
* [[Cyanosis|Cyanotic]] and cold skin, lips, nail bed (suggestive of [[cardiogenic shock]]) | |||
===Abdomen=== | |||
* [[Ascites]] (suggestive of [[Budd Chiari syndrome]], that is [[hepatic vein thrombosis]]) | |||
* [[Hepatomegaly]] (suggestive of [[Budd Chiari syndrome]], that is hepatic vein thrombosis) | |||
===Heart=== | |||
Among patients with [[DVT]] complicated by [[PE]], the following might be present: | |||
* [[Cardiac murmur]] | |||
** [[Graham-Steell murmur]] (suggestive of [[pulmonary regurgitation]]) | |||
* [[Accentuated P2]] | |||
* [[S3]] or [[S4]] gallop (suggestive of [[RV dysfunction]]) | |||
* [[Jugular venous distention]] (suggestive of [[right heart failure]]) | |||
===Lungs=== | |||
Among patients with [[DVT]] complicated by [[PE]], the following might be present: | |||
* [[Rales]] | |||
* [[Crackles]] | |||
* [[Pleural friction rub]] | |||
==References== | |||
{{reflist|2}} | |||
[[Category:Disease]] | |||
[[Category:Cardiology]] | |||
[[Category:Hematology]] | [[Category:Hematology]] | ||
[[Category: | [[Category:Angiology]] | ||
[[Category:Emergency medicine]] | [[Category:Emergency medicine]] | ||
[[Category: | [[Category:Vascular surgery]] | ||
[[Category:Up-To-Date]] | |||
[[Category:Cardiovascular diseases]] | |||
{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
Latest revision as of 12:01, 13 July 2014
 |
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.; Justine Cadet; Rim Halaby, M.D. [3]
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Deep vein thrombosis physical examination On the Web |
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Risk calculators and risk factors for Deep vein thrombosis physical examination |
Overview
The physical examination may be completely normal in patients with DVT. A high degree of suspicion is necessary for early identification of venous thrombosis, as sometimes these patients are admitted with a different complaint and a thorough physical exam gives a clue to the diagnosis. The typical symptoms of DVT include unilateral calf or thigh tenderness, swelling, and/or erythema. Since DVT can be complicated by pulmonary embolism (PE), the physical exam should include assessment of the signs of PE, such as tachypnea and tachycardia among others.
Physical Examination
Vitals
- Temperature, blood pressure, heart rate and respiratory rate may all be within normal range in DVT.
- Among patients with DVT complicated by PE, the following might be present:
- Blood pressure lower than baseline, suggestive of cardiogenic shock (associated with tachycardia and end organ hypoperfusion)
- Tachycardia (26%)[1]
- Tachypnea (70%)[1]
- Low grade fever
Extremities
One of the most significant part of the physical exam in a patient with a suspected DVT is the measurement of the size of both legs at the same point (usually measured vertically from the knee joint), to assess for differences. If a difference is detected, and there is suspicion of DVT, further tests should be conducted. The complete exam of the extremities should include the assessment of all the following:
- Unilateral calf or thigh tenderness
- Unilateral calf or thigh pitting edema
- Unilateral calf or thigh swelling
- Difference in calf diameters > 3 cm (the calf circumference is measured 10 cm below the tibial tuberosity)
- Difference in thigh diameters (the thigh circumference is measured 10-15 cm above the patella)
- Unilateral calf or thigh warmth
- Unilateral calf or thigh erythema
- Palpable cord (a thickened palpable vein suggestive of thrombosed vein)
- Dilatation of unilateral collateral superficial veins
- Localized tenderness upon palpation of the deep veins
- Posterior calf
- Popliteal fossa
- Inner anterior thigh
Skin
- Generalized edema (suggestive of right heart failure, or nephrotic syndrome)
- Cyanotic and cold skin, lips, nail bed (suggestive of cardiogenic shock)
Abdomen
- Ascites (suggestive of Budd Chiari syndrome, that is hepatic vein thrombosis)
- Hepatomegaly (suggestive of Budd Chiari syndrome, that is hepatic vein thrombosis)
Heart
Among patients with DVT complicated by PE, the following might be present:
- Cardiac murmur
- Graham-Steell murmur (suggestive of pulmonary regurgitation)
- Accentuated P2
- S3 or S4 gallop (suggestive of RV dysfunction)
- Jugular venous distention (suggestive of right heart failure)
Lungs
Among patients with DVT complicated by PE, the following might be present:
References
- ↑ 1.0 1.1 Torbicki A, Perrier A, Konstantinides S, Agnelli G, Galiè N, Pruszczyk P; et al. (2008). "Guidelines on the diagnosis and management of acute pulmonary embolism: the Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC)". Eur Heart J. 29 (18): 2276–315. doi:10.1093/eurheartj/ehn310. PMID 18757870.