clinical features
Last reviewed 07/2021
The classical features of DVT are noted in only half of cases, and include:
- pain and tenderness
- pain may
- vary from an ache to cramping, from dull to sharp and from mild to severe
- be intermittent or constant
- aggravated by movement and standing up and relived by elevating the leg (1)
- local swelling and warmth
- mild pyrexia
- persistent tachycardia
During physical examination the following may be observed.
- palpable cord of a thrombosed vein
- tender, palpable solid cord may be felt in the popliteal fossa or the groin
- superficial venous dilation
- relatively uncommon
- distension of the superficial veins may be caused by obstruction but is equally seen after a long walk in high temperature
- unilateral oedema,
- can be due to obstruction of the proximal veins or due to inflammation of the perivascular tissue
- usually seen distal to the site of obstruction and may be painless
- pain, inflammation or erythema may be seen if associated with inflammation
- warmth (1,2)
The exact presentation depends upon the site of thrombosis:
- involving the calf-veins - calf swelling is usually modest. Homan's sign is positive but the test is not recommended because of the risk of pulmonary embolism.
- involving the femoral vein - calf is swollen with local tenderness in the popliteal region or adductor canal.
- involving the ilio-femoral veins - diffuse, and sometimes massive swelling of the entire lower limb. May progress to phlegmasia alba dolens, and in severe cases, to phlegmasia cerulia dolens.
When it occurs after an operation, the features of DVT are usually noted towards the end of the first post-operative week. They may occur earlier if the patient has been in hospital for some time pre-operatively. Careful scrutiny of the temperature chart and daily examination of the legs may predict impending thrombosis.
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