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Isolated distal deep venous thrombosis
From WikEM
Contents
Background
- Isolated tibial or peroneal DVTs
- Up to 25% IDDVTs propagate in hospitalized patients, but incidence is lower in ambulatory patients
Clinical Spectrum of Venous thromboembolism
- Deep venous thrombosis (uncomplicated)
- Phlegmasia alba dolens
- Phlegmasia cerulea dolens
- Venous gangrene
- Pulmonary embolism
- Isolated distal deep venous thrombosis
Only 40% of ambulatory ED patients with PE have concomitant DVT[1][2]
Clinical Features
- See DVT
Differential Diagnosis
Calf pain
- DVT
- Compartment syndrome
- Gastrocnemius strain
- Calcaneal bursitis
- Achilles tendon rupture
- Cellulitis
- Superficial thrombophlebitis
- Ruptured Popliteal cyst (Baker's)
Evaluation
- US
Management
- Repeat DVTscan in 2-5 days to look for clot propagation
- May require anticoagulation for 3 months if clot extends proximally
Disposition
- Case by case basis, with discharge and follow up ultrasound as reasonable option
- Must weight risk of bleeding of anticoagulation with risk of clot propagation
See Also
References
- Kline JA. Pulmonary Embolism and Deep Vein Thrombosis, in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 8. St. Louis, Mosby, Inc., 2013, (Ch) 88: p 1157-1170.
- Guyatt GH, Akl EA, Crowther M, Gutterman DD, Schuünemann HJ. Chest. 2012;141(2_suppl):7S-47S. doi:10.1378/chest.1412S3.
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