The Rational Clinical Examination
David L. Simel, Drummond Rennie
Deep Vein Thrombosis
Philip S. Wells, Carolyn Owen, Steve Doucette, Dean Fergusson, Huyen Tran
Clinical Scenario
Topics Discussed:
deep vein thrombosis
Excerpt:
"A 60-year-old man referred with suspected deep vein thrombosis
(DVT) cut the plantar surface of his left foot on glass 10 days
ago and has been resting in bed. He presents with left leg pain
and mild calf swelling, redness, and heat. There is no history of
a DVT or known family history of venous thromboembolism. Physical examination
shows the patient is febrile and has pitting edema of the left calf.
The calf erythema is hot, tender, and well demarcated. Enlarged
left inguinal lymph nodes are present. He has longstanding diabetes
mellitus, and the diagnoses that seem most likely are cellulitis and
DVT. Can a clinical probability estimate of DVT reliably determine
a pretest probability that can be used in decision making?..."
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