Clinical signs and symptoms of pe as the primary

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-Clinical signs and symptoms of PE as the primary manifestation occur in 10-50% of patients with confirmed DVT. -The pain and tenderness associated with DVT does not usually correlate with the size, location, or extent of the thrombus. -Warmth or erythema of skin can be present over the area of thrombosis
DVT Physical ExamoSuperficial thrombophlebitis is characterized by the finding of a palpable, indurated, cordlike, tender, subcutaneous venous segment.oForty percent of patients with superficial thrombophlebitis without coexisting varicose veins and with no other obvious etiology (e.g., intravenous catheters, intravenous drug abuse, soft tissue injury) have an associated DVT.
DVT Differential DiagnosisIn one study of 160 consecutive patients with suspected DVT who had negative venograms, the following causes of leg pain were identified:Muscle strain, tear, or twisting injury to the leg — 40 percent Leg swelling in a paralyzed limb — 9 percent
DVT Differential DiagnosisLymphangitis or lymph obstruction — 7 percent Venous insufficiency (reflux) — 7 percent Baker's cyst — 5 percent Cellulitis — 3 percent Knee abnormality — 2 percent Unknown — 26 percent
DVT DiagnosisThe clinical assessment of patients with suspected DVT is often difficult because of the interplay between risk factors and the nonspecific nature of the physical findings.Clinicians have observed that a discordance is often present between the clinical assessment and the results of objective testing.
DVT DiagnosisOne report of 593 patients with suspected DVT validated a measure of pretest probability in conjunction with an algorithm designed to minimize the use of venography or repeat ultrasonography.The measure of pretest probability is referred to as the Wells score or Wells criteria for DVT probability:
DVT DiagnosisThe Wells clinical prediction guide quantifies the pretest probability of DVT. The model enables providers to reliably stratify their patients into high-, moderate-, or low-risk categories. Combining this with the results of objective testing greatly simplifies the clinical workup of patients with suspected DVT. The Wells clinical prediction guide incorporates risk factors, clinical signs, and the presence or absence of alternative diagnoses.
DVT DiagnosisFor example, patients deemed to be at high risk for DVT may have a negative finding on duplex ultrasonographic study. In this case, the probability of DVT is still greater than 20% when the known sensitivity, specificity, and negative likelihood ratio of duplex ultrasonography are considered. Having an objective method to determine pretest probability simplifies clinical management.
Wells ScoreParalysis, paresis, or recent orthopedic casting of a lower extremity (1 point) Recently bedridden for longer than three days or major surgery within the past four weeks (1 point) Localized tenderness in the deep vein system (1 point) Swelling of an entire leg (1 point)

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