Anatomy Msk · Year 1 · from Anatomy Msk
Case 2: Deep Vein Thrombosis (DVT) of the Lower Extremity
Clinical Image
Source: Wikimedia Commons - DVT Ultrasound - CC BY-SA 3.0
Case Presentation
A 48-year-old woman presents with 3 days of progressive left leg swelling and pain. She had knee arthroscopy for meniscal repair 2 weeks ago and has been relatively immobile since then. She reports her left calf has been aching and feels "heavy." She denies chest pain, shortness of breath, or hemoptysis. Risk factors include oral contraceptive use and a 6-hour flight 3 weeks before surgery. Physical examination reveals unilateral left lower extremity edema, with the left calf circumference 4 cm greater than the right. The left calf is warm, erythematous, and tender to palpation. Homan sign is positive (calf pain with passive dorsiflexion), though this is unreliable. There is no palpable cord. Venous duplex ultrasound demonstrates a non-compressible left popliteal vein and proximal femoral vein with echogenic material consistent with thrombus. She is diagnosed with acute proximal lower extremity DVT and started on anticoagulation with low-molecular-weight heparin bridged to warfarin. She is educated on DVT prophylaxis and instructed to wear compression stockings.
Key Learning Points
- The deep veins of the leg include popliteal, femoral, and iliac veins; they accompany the major arteries
- Virchow's triad: stasis, endothelial injury, and hypercoagulability predispose to venous thrombosis
- Proximal DVT (popliteal and above) has higher risk of pulmonary embolism than distal DVT
- Clinical signs include unilateral leg swelling, warmth, erythema, and calf tenderness; Wells criteria guide testing
- Duplex ultrasound with compression is the diagnostic test of choice; inability to compress the vein indicates thrombus