Deep vein thrombosis physical examination: Difference between revisions

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=== Extremities ===
=== Extremities ===
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. It may also reveal:
* 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 assessment of all the following:
* Palpable cord (reflecting a thrombosed vein)
** Unilateral calf or thigh tenderness
* Calf or thigh pain
** Unilateral calf or thigh [[pitting edema]]
* Unilateral [[edema]] or swelling with a difference in calf diameters, warmth, tenderness and [[erythema]].
** Unilateral calf or thigh swelling
* Superficial venous dilation.
** 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)
'''[[Homans test]]''' is mainly of historical perspective. It is said to be positive when passive dorsiflexion of the ankle (knee in flexed position) elicits sharp pain in the calf. However, the test has a very poor positive or negative predictive value. Previous studies have shown that Homans test was present only in 30% of the patients with positive [[DVT]].
** Unilateral calf or thigh warmth
 
** Unilateral calf or thigh [[erythema]]
'''Pratt's sign''': When squeezing of posterior calf elicits pain. This is not recommended.<ref name="pmid16403932">{{cite journal| author=Wells PS, Owen C, Doucette S, Fergusson D, Tran H| title=Does this patient have deep vein thrombosis? |journal=JAMA | year= 2006 |volume= 295 | issue= 2 | pages= 199-207 | pmid=16403932 | doi=10.1001/jama.295.2.199 | pmc=|url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16403932  }}[http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16813372 Review in: ACP J Club. 2006 Jul-Aug;145(1):24] [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17213132 Review in: Evid Based Med. 2006 Aug;11(4):119] </ref>
** 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
* The physical exam should also include assessment of the following:
** Generalized [[edema]] (suggestive of [[nephrotic syndrome]])
** [[Ascites]] (suggestive of [[Budd Chiari syndrome]], that is [[hepatic vein thrombosis]])
** [[Hepatomegaly]] (suggestive of [[Budd Chiari syndrome]], that is hepatic vein thrombosis)


==References==
==References==

Revision as of 20:49, 5 June 2014

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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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.

Physical Examination

Vitals

Temperature, blood pressure, heart rate and respiratory rate may all be within normal range.

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 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
  • The physical exam should also include assessment of the following:

References

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