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


At present, compression ultrasonography is the preferred initial diagnostic test when symptoms and signs suggest acute deep vein thrombosis (Fig. 1). A positive test confirms the diagnosis. A negative compression ultrasound examination requires additional testing because calf vein thrombosis may go undetected. Venography or magnetic resonance imaging may be necessary if serial compression ultrasonography cannot be performed or if iliac vein thrombi are suspected.

Figure 1.

Diagnostic approach to patients with symptoms suggesting acute deep venous thrombosis.
*First episode of suspected (symptomatic) acute lower extremity DVT
† Duplex or color-flow US may be utilized, although there is no proven superiority over compression US alone. Scenarios associated with false-positive IPG and duplex studies must be realized.
‡ Because the sensitivity of US or IPG for calf DVT is lower than for proximal DVT, three studies over 7 to 14 d (IPG) or one repeat study 5 to 7 days after the first normal study (US) are needed to detect proximal extension. If a patient cannot return for a repeat study, if iliac thrombosis is suspected, or if an urgent diagnosis is deemed necessary, a more rapid evaluation using venography (or MRI) should be undertaken.
§ Although MRI appears accurate for lower extremity DVT, it is more expensive than US or IPG and is generally not indicated as the initial diagnostic test.


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