Acute Deep Vein Thrombosis
A 29 year-old male patient came in for a left lower extremity venous duplex. The patient was a hemipalegic with the chief complaint of left leg swelling. In this exam the deep venous system of the lower extremity was examined using color duplex ultrasound with the following noted: The anterior tibial and peroneal veins were visualized, and were noted to have spontaneous and phasic flow, fully compressible, augmented normally, and without evidence of intraluminal echoes. The common femoral, profunda, superficial femoral, popliteal, and posterior tibial veins appeared dilated, non- compressible, and with no flow. The final impression was positive for acute deep vein thrombosis in the common femoral, profunda femoral, superficial femoral, popliteal, and posterior tibial veins.
Some correlating imaging modalities other than Doppler ultrasound include: D- Dimer assay for DVT screening test, contrast venography, and impedance plethysmography (IPG) (http://enotes.tripod.com/pe.htm, Retrieved June 3, 2008).
Acute deep vein thrombosis is the formation of a stationary blood clot in one or more deep veins of the legs. The calf veins are the most common sites for thrombus, but 40% of DVTs occur in the femoral and iliacs behind the valves. Symptoms of a DVT are pain, swelling, warmth, and redness in the affected limb (Meissner, M., & Strandness, E., 1999, p.1).
Three main factors in the development of DVT are abnormalities in blood, or abnormalities of the blood itself, and injury to the blood vessel wall. Imbalance of the coagulation system and fibrinolytic system causing a hypercoagulable state within the body and are thought to be the most important factors in acute DVT (p.1).
Risk of acute DVT increases with the number of risk factors that a person has. Some risk factors are age, surgery, trauma, malignancies, previous DVT, immobilization, primary (genetic) hypercoagulable states, oral contraceptives and hormone therapy, and other variable factors (p.2).
A complication of DVT is pulmonary embolism which is a blockage or closure caused by a clot in the lung. This complication is potentially life-threatening accounts for about 10% of patients with acute DVT events. Another complication is post- thrombotic syndrome which occurs later but is more common. Possible signs and symptoms are pain, edema, hyperpigmentation, and skin ulceration (p.3).
Prevention of a DVT includes: intermittent pneumatic compression or pneumatic plantar compression, supportive or graduated compression stockings, and leg exercise or early ambulation if possible. You can treat a DVT with Lovenox, Heparin IV, Coumadin, thrombolytic rx for PE & DVT, vena cava interruption, and surgical thrombectomy (http://enotes.tripod.com/pe.htm, Retrieved June 3, 2008).
Bibliography
http://www.enotes.tripod.com/pe.htm, Retrieved June 3, 2008.
http://www.mghradrounds.org/clientuploads/may_2005/us.jpg, Retrieved June 4, 2008.
Meissner, M. & Strandness E. Acute deep vein thrombosis and complications. American
Venous Forum, Ch. 2, p. 1-3.