Deep vein thrombosis physical examination: Difference between revisions
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== Physical Examination == | == Physical Examination == | ||
=== Vitals === | === Vitals === | ||
Temperature, [[blood pressure]], [[heart rate]] and [[respiratory rate]] may all be within normal range. | * 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 === | === 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 [[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=== | |||
** [[Ascites]] (suggestive of [[Budd Chiari syndrome]], that is [[hepatic vein thrombosis]]) | * 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== | ==References== | ||
Revision as of 20:58, 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 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 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:
- Rales
- Crackles
- Pleural friction rub
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.