Diagnosis of Lower-Extremity Deep Vein Thrombosis in Outpatients

Abstract

A 68-year-old man was referred to your outpatient clinic following a cemented right hip arthroplasty procedure 3 weeks before your examination. He reports that he has had pain in his right calf and thigh since being discharged from the hospital and that these symptoms limit his ability to ambulate. He also reports difficulty getting in and out of bed. You find that he has a swollen right lower extremity and that he complains of pain when you palpate his right posterior calf and knee. You suspect that he may have a deep vein thrombosis (DVT), but you also consider that it is likely that the lower-extremity symptoms are attributable to the recent surgical procedure. Do you contact the patient's physician? The diagnosis of DVT in patients who are hospitalized is well recognized, but DVT associated with outpatient care is less frequently discussed.1 The purpose of this update is to summarize evidence-based approaches to the clinical examination of outpatients who are at risk for DVT. We also review radiological and laboratory-based diagnostic tests used to confirm or refute the diagnosis of DVT. Venous thromboembolism (VTE) is a vascular disease that manifests as DVT or pulmonary embolism (PE). Both DVT and PE can be symptomatic or asymptomatic. Newly diagnosed cases of symptomatic VTE are estimated to occur in approximately 250,000 Americans per year, and DVT accounts for approximately two thirds of these cases.2 Deep vein thrombosis most commonly appears in the lower extremity and is typically classified as being either proximal (affecting the popliteal and thigh veins) or distal (affecting the calf veins). Proximal deep vein thrombosis (PDVT) is the more dangerous form of lower-extremity DVT because it is more likely to cause life-threatening PE and may result in a greater risk of postthrombotic syndrome.3,4 Calf DVT, …