Deep vein thrombosis diagnosis specific situations: Difference between revisions
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{{Deep vein thrombosis}} | {{Deep vein thrombosis}} | ||
==Overview== | ==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 the American College of Chest Physicians. | 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 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. | |||
* If | * Initial test in these patients should be [[Deep vein thrombosis ultrasound|compression ultrasound]] if previous ultrasound is available for comparison or highly-sensitive [[Deep vein thrombosis D-dimer|D-dimer]]. | ||
* 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== | ||
* If | * Initial test should be proximal [[Deep vein thrombosis ultrasound|compression ultrasound]]. | ||
* If 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 D-dimer at presentation should be done. | |||
* Dopper 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) in 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 [[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 [[Deep vein thrombosis ultrasound|compression ultrasound]] or 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== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
Revision as of 17:15, 20 May 2012
Editors-in-Chief: C. Michael Gibson, M.S., M.D. Associate Editor-In-Chief: Kashish Goel, M.D.; Ujjwal Rastogi, MBBS[1]
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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 the American College of Chest Physicians[1].
Recurrent DVT
- Patients suspected to have a recurrent episode of DVT may benefit from thrombophilia evaluation.
- Initial test in these patients should be compression ultrasound if previous ultrasound is available for comparison or highly-sensitive D-dimer.
- If the compression ultrasound results are abnormal but nondiagnostic (increase in residual venous diameter of <4 but ≥2 mm), further testing with venography or CT venography may be indicated.
Pregnant patients
- Initial test should be proximal compression ultrasound.
- If initial proximal compression ultrasound is negative, serial testing with either proximal compression ultrasound at day 3 and day 7 or D-dimer at presentation should be done.
- Dopper 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 (compression ultrasound with either Doppler to color Doppler) in 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 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 compression ultrasound as the first test.
- If positive, then treatment should be started.
- If negative, repeat compression ultrasound or D-dimer testing should be done in 1 week.
Positive D-dimer only
- If the initial D-dimer is positive, but compression ultrasound is negative, a repeat 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
- ↑ Bates SM, Jaeschke R, Stevens SM; et al. (2012). "Diagnosis of DVT: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines". Chest. 141 (2 Suppl): e351S–418S. doi:10.1378/chest.11-2299. PMID 22315267. Unknown parameter
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