Image Based Question-72013

This 60-year-old man underwent pelvic surgery 6 days ago. He complained of a painful right calf.What can be the most possible diagnosis?

A. Lymphedema

B. Deep Vein Thrombosis

C. Superficial thrombophlebitis

D. Cellulitis

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Correct Answer » B Explanation

Ans:B. Deep Vein Thrombosis.

Deep venous thrombosis (DVT)

• It is a manifestation of venous thromboembolism .

Symptoms of DVT may include the following:

• Edema – Most specific symptom
• Leg pain – Occurs in 50% of patients but is nonspecific
• Tenderness – Occurs in 75% of patients
• Warmth or erythema of the skin over the area of thrombosis
• Clinical symptoms of pulmonary embolism as the primary manifestation.

Physical findings in DVT may include the following:

• Calf pain on dorsiflexion of the foot (Homans sign)
• A palpable, indurated, cordlike, tender subcutaneous venous segment
• Variable discoloration of the lower extremity
• Blanched appearance of the leg because of edema (relatively rare)

Potential complications of DVT include the following:

• As many as 40% of patients have silent PE when symptomatic DVT is diagnosed [4]
• Paradoxic emboli (rare)
• Recurrent DVT
• Postthrombotic syndrome (PTS).

Diagnosis:

• Ultrasound Doppler and duplex imaging of the calf veins, venography,D-Dimer
• Coagulation studies (eg, prothrombin time and activated partial thromboplastin time) to evaluate for a hypercoagulable state.

Treatment options for DVT include the following:

• Anticoagulation (mainstay of therapy) – Heparins, warfarin, factor Xa inhibitors, etc.
• Pharmacologic thrombolysis
• Endovascular and surgical interventions:

• Thrombus removal with catheter-directed thrombolysis
• Mechanical thrombectomy
• Angioplasty
• Stenting of venous obstruction

• Physical measures (eg, elastic compression stockings and ambulation)