The Diagnostic Approach to Deep Venous Thrombosis

C. Gregory Elliott, MD, Departments of Medicine and the Pulmonary Divisions of the LDS Hospital and University of Utah Health Sciences Center, Salt Lake City, Utah

Semin Respir Crit Care Med. 2000;21(6) 

In This Article

Abstract and Introduction

Abstract

Accurate diagnosis of deep vein thrombosis is important because untreated deep vein thrombosis can cause death or permanent impairment and because effective treatments are available. The approach to the diagnosis of deep vein thrombosis varies because of differences in local resources and expertise. Duplex ultrasonography with venous compression is the preferred initial test for the majority of outpatients who present with symptoms and signs that suggest acute deep vein thrombosis. Clinical outcome studies have shown the safety of withholding anticoagulants when two compression ultra-sonography examinations are negative over a 5- to 7-day period. Alternative strategies, for example, combining clinical scores and D-dimer with compression ultrasonography, may also prove effective. In unusual circumstances, venography or even magnetic resonance imaging may be necessary.

Introduction

Accurate diagnosis of thromboses that involve the deep veins is important because untreated deep vein thrombosis can cause death or permanent impairment and because effective treatments are available. More than 60,000 Americans die each year from acute pulmonary embolism, a consequence of undiagnosed deep vein thromboses.[1] Pulmonary thromboembolism is also a leading cause of maternal mortality.[2,3]

The diagnosis of deep vein thrombosis remains challenging, in spite of extensive investigation of diagnostic approaches and in spite of technologic advances. The broad spectrum of deep vein thrombosis creates diagnostic challenges, as do the limitations of diagnostic tests. For example, deep vein thromboses may be extensive in symptomatic patients and easily diagnosed by compression ultra-sonography, [4] or deep vein thrombi may be small and nonocclusive in asymptomatic-high risk patients. Small nonocclusive thrombi are often missed by compression ultrasonography.[5] Similarly, compression ultrasonography often fails to detect deep vein thrombi isolated to the iliac veins.[6]

The aim of the present article is to describe diagnostic tests and diagnostic approaches for deep vein thrombosis based upon current scientific evidence. The article provides an overview of each test followed by a description of diagnostic approaches based upon the clinical setting (problem).

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