Trombus ~ solid mass of blood constituents formed within vascular system during life

Virchow's triad : (predisposing factors)
1. Intimal changed of the vessel ( Eg turbulent blood flow)
2. Stasis of blood
3. Blood constituents ( Eg increased viscosity of blood)

Presention:
  • Unilateral leg swelling which is painful, warm and bluish appearance due to dilatation of superficial vein
  • so painful that patient don allow other to touch the swelling
  • Low grade fever
Well scoring's system : (for predicting pre-test probability of DVT)
  • Active cancer ( received therapy in previous 6 months/ currently on palliative treatment)
  • Paralysis/ paresis/ recent plaster immobilisation of lower extremities
  • Recently bedridden > 3 days / major surgery previous 12 weeks requiring general or regional anesthesia
  • Localised tenderness along distribution of deep venous system
  • Entire leg swollen
  • Calf swelling at least 3 cm larger than that of the asymptomatic site (measure 10 cm below tibial tuberosity)
  • Pitting edema
  • Collateral superficial vein (non varicose)
  • previously documented DVT
  • Alternative diagnosis at least as likely as DVT --> -2 mark
--> each point carry one mark except the last point

Clinical probability
< 2 -- DVT unlikely
equal or >2 -- DVT likely


Differential diagnosis of swollen leg
  • Calf hematoma -- History of trauma
  • Skin inflammation
  • Pelvic disease obstructing venous/ lymphatic return (Eg pelviv tumour - mass? Loss of appetite/weight? Menstrual irregularities?)
  • CCF/ cor polmonale (Features of cardiac failure -- Orthopnea, PND, decreased tolerance)
  • Hypoalbuminemia (Ascites, facial puffiness, pedal edema)
Investigation:
Medium/ high risk -- venography or ultrasound
Low risk -- Plasma D- dimer level


Treatment
Depend on -- 1) site
2) extent
3) age of thrombus
Weigh the indication and contraindication of giving anticoagulant in this patient
-- Heparin (LMWH - subcutaneously)
-- Warfarin (oral)