cardiovascular disorders
Deep Venous Thrombosis (DVT)
Symptoms and Signs of Deep Venous Thrombosis
DVT may occur in ambulatory patients or as a complication of surgery or major medical illness. Among patients who are hospitalized and at high risk, most deep vein thrombi occur in the small calf veins, are asymptomatic, and may not be detected. When present, symptoms and signs of DVT (eg, vague aching pain, tenderness along the distribution of the veins, edema, erythema) are nonspecific, vary in frequency and severity, and are similar in arms and legs. Dilated collateral superficial veins may become visible or palpable. Calf discomfort elicited by ankle dorsiflexion with the knee extended (Homans sign) occasionally occurs with distal leg DVT but is neither sensitive nor specific. Tenderness, swelling of the whole leg,>3 cm difference in circumference between calves, pitting edema, and collateral superficial veins may be most specific; DVT is likely with a combination of≥3 in the absence of another likely diagnosis (see table). Low-grade fever may be present; DVT may be the cause of fever without an obvious source, especially in postoperative patients. Symptoms and Signs , if it occurs, may include shortness of breath and pleuritic chest pain. Common causes of asymmetric leg swelling that mimic DVTare Soft-tissue trauma Cellulitis None Compression of a pelvic vein Obstruction of a lymphatic vessel in the pelvis Popliteal cyst ( Baker Cysts ) that obstructs venous return Less common causes include abdominal or pelvic tumors that obstruct venous or lymphatic return. Symmetric bilateral leg swelling is the typical result of use of medications that cause dependent edema (eg, dihydropyridine calcium channel blockers,estrogen, high-dose opioids), venous hypertension (usually due to right heart failure), and hypoalbuminemia; however, such swelling may be asymmetric if venous insufficiency coexists and is worse in one leg. Common causes of calf pain that mimic acute DVTinclude Chronic Venous Insufficiency and Post-Thrombotic Syndrome None Cellulitis that causes painful erythema of the calf Ruptured popliteal (Baker) cyst (pseudo-DVT), which causes calf swelling, pain, and sometimes bruising in the region of the medial malleolus Partial or complete tears of the calf muscles or tendons 