Presentation and Diagnosis of DVT

Patients will often present with a deep vein thrombosis. The reason that this may be suspected is that they will complain of pain in the leg, maybe on walking, swelling and redness. Very occasionally, it may just present with a patient having a fever, but usually there will be symptoms in the leg. However, occasionally you can get an asymptomatic DVT that is detected when somebody is being investigated for another cause. Usually, depending on the extent of the deep vein thrombosis, if it is just a clot in the calf vessels, it's likely just to be pain with some minimal swelling. If the clot is in the veins in the thigh or in the iliac veins, which are the veins in the abdomen which drain the legs independently then this is likely to be associated more with more extensive swelling and pain. Usually people will present to their doctor or to their A&E department and once a history is taken there is something called the well scoring system which the healthcare professional might complete which has has various factors that are ticked off which will indicate whether you are at a high diagnostic risk of having had a deep vein thrombosis. Then it is likely that a blood test will be done which is called a D-dimer test and if this number is above 500 it is likely to confirm that you have had a deep vein thrombosis. That number may alter depending on which laboratory your blood test is sent to. If the clinical suspicion is high on the WELL score and the D-dimer test is unremarkable, there are two options that may be done. A repeat D-dimer in a couple of days' time or send somebody, if there's a high clinical suspicion, to go on and have a duplex ultrasound test. This is a scan which is very similar to that which you'll see pregnant mothers have to look at their babies. This is an ultrasound test where we look to see if there is any clot in the leg and if this is positive then the patient is recommended to go on to receive formal treatment in the form of anticoagulation. If the clinical suspicion is high and the duplex is negative or just shows some small clot in the calf veins there may some discussion as to whether the patient needs to have a repeat scan in a week's time because there is a bit of controversy as to what to do with people with calf vein DVT. The recommendations are that if you have significant symptoms and you have a calf DVT then you should be treated with anticoagulation. However if they are minor symptoms or asymptomatic there is a recommendation that you can safely just rescan the patient in a week's time see if there is any further extension of the clot and then implement the role of anticoagulation if there has been any further extension of the clot. There are obviously many other forms of treatment if you have got somebody with a significantly swollen leg there may be some discussion and I would recommend that you maybe listen to one or two other videos or discuss with your healthcare professional the role of thrombolysis. How quickly do the signs and symptoms of a DVT develop and how long do they last for? The signs and symptoms of a DVT can actually take anything up to a week or two to actually present because somebody can develop a clot in the calf and probably have no symptoms then extends further up the leg and their symptoms then actually get worse as more of the veins are blocked off. But overall it's very hard to actually give an absolute number as to how long it takes for the symptoms to develop because there are no natural history studies of people being scanned, a diagnosis made and then followed up. Sometimes the symptoms will come on gradually and other patients it will come in on no symptoms and they'll suddenly have very marked symptoms of pain and leg swelling, so they are very variable. But the key things are if you have got a painful leg on one side with swelling, maybe with redness and possibly a temperature, the key thing to rule out is a deep vein thrombosis. And finally, can you develop a DBT anywhere in the Deep vein thrombosis can occur anywhere in the body. They can obviously occur in the legs, they can occur in the pelvic veins, they can occur in the abdominal veins and they can occur in the veins draining the upper limb, they can occur in the veins draining the neck and they can also occur in the veins draining the gut and they will all, depending on which part of the body they drain, present with different symptomatology. For example, if you have a thrombosis in the veins draining the neck, this can be associated with swelling of the face, headache, and what's very important that if you develop any of the symptoms of swelling and pain in any of the extremities of the body that you should present to a healthcare professional for them to make an appropriate diagnosis. For example the other area that I just mentioned very briefly and it is very rare that if you get a thrombosis in the veins draining your bowels you will possibly present with abdominal pain and and something called peritonitis, which is similar to how people will present if they've had an abdominal problem such as a perforated peptic ulcer or appendicitis where they will get things like peritonitis. So this is all something to consider that needs to be considered by your healthcare professional.