Deep vein thrombosis physical examination: Difference between revisions
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The patient may complain of lower limb pain. | The patient may complain of lower limb pain. | ||
==Vitals== | ==Vitals== | ||
Temperature, Blood Pressure, Pulse and Respiratory rate may all be within normal range. | |||
==Physical examination== | ==Physical examination== | ||
Physical examination may reveal | Physical examination may reveal | ||
Revision as of 19:27, 24 April 2012
Editors-in-Chief: C. Michael Gibson, M.S., M.D. Associate Editor-In-Chief: Ujjwal Rastogi, MBBS [1]
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Overview
The actual physical signs of venous thrombosis can be quite unreliable. There may be pain and tenderness in the thigh along the course of the major veins
Appearance of the Patient
Obesity may be present.
The patient may complain of lower limb pain.
Vitals
Temperature, Blood Pressure, Pulse and Respiratory rate may all be within normal range.
Physical examination
Physical examination may reveal
- Palpable cord (reflecting a thrombosed vein)
- Calf or thigh pain
- Unilateral edema or swelling with a difference in calf diameters, warmth, tenderness and erythema.
- Superficial venous dilation.
Test
- Homan's test: is said to be present when passive dorsiflexion of the ankle by the examiner elicits sharp pain in the calf.. A positive Homans sign does not positively diagnose DVT (poor positive predictive value), and a negative Homans sign does not rule out the DVT diagnosis (poor negative predictive value).
- Pratt's sign: Squeezing of posterior calf elicits pain
However, these medical signs do not perform well and are not included in clinical prediction rules that combine best findings in order to diagnose DVT.[1]
Screening for malignancy
Venous thromboembolism may be the first manifestation of an underlying malignancy. However, a detailed and routine search for an occult malignancy is neither mandatory nor cost effective.[2]
The following test should be considered:
In Males
- Rectal Examination
- Fecal occult blood testing (FOBT) must be performed.
In Females
- Pelvic examinations to rule out any mass/malignancy.
References
- ↑ Wells PS, Owen C, Doucette S, Fergusson D, Tran H (2006). "Does this patient have deep vein thrombosis?". JAMA. 295 (2): 199–207. doi:10.1001/jama.295.2.199. PMID 16403932. Review in: ACP J Club. 2006 Jul-Aug;145(1):24 Review in: Evid Based Med. 2006 Aug;11(4):119
- ↑ Oudega R, Moons KG, Karel Nieuwenhuis H, van Nierop FL, Hoes AW (2006). "Deep vein thrombosis in primary care: possible malignancy?". Br J Gen Pract. 56 (530): 693–6. PMC 1876636. PMID 16954002.