Snapshot A 45-year-old woman presents to the emergency room for pain in her left calf. She reports flying back to the United States from Australia 2 days ago. Her flight was nonstop, making it a > 12-hour flight. She states having not worn any compression stockings and notes some swelling in the lower extremities bilaterally after the flight. She has a past medical history of hypertension and diabetes and currently takes oral contraceptive pills. Her vital signs are normal. On physical exam, her left calf is 2 cm larger in circumference than her right calf. It is also erythematous and warm with pitting edema. Her D-dimer levels are elevated. Introduction Clinical definition blood clot in the deep veins, typically of the lower extremities Associated conditions pulmonary embolism Epidemiology Incidence increases with age Location lower extremities Risk factors immobility hospitalization surgery thrombophilia malignancy trauma state of elevated estrogen patients on estrogen for hot flashes login to view 2 more bullets Pathogenesis Virchow triad puts patients at risk for DVTs venous stasis login to view 1 more bullet hypercoagulability login to view 1 more bullet endothelial damage login to view 2 more bullets Presentation Symptoms lower extremity pain and swelling Physical exam examination of the affected extremity redness warmth Homan sign login to view 2 more bullets shortness of breath may indicate pulmonary embolism Imaging Compression ultrasound with Doppler indications all patients diagnostic gold standard findings clot formation in deep venous system Studies Labs D-dimer high sensitivity low specificity often used to rule out DVT Differential Cellulitis distinguishing factors no clot found on ultrasound patients may have systemic signs, such as a fever D-dimer is negative Diagnosis Making the diagnosis based on clinical presentation and imaging Treatment Management approach most patients undergo anticoagulation for 3-6 months however, if the DVT is unprovoked with no identifiable cause, or if risk factors are persistent, patients may require longer periods of anticoagulation for prophylaxis of future DVTs Conservative appropriate prophylaxis indication login to view 1 more bullet modalities login to view 2 more bullets Medical direct oral anticoagulants drugs login to view 2 more bullets indication login to view 2 more bullets low-molecular-weight heparin (LMWH) indications login to view 2 more bullets unfractionated heparin indication login to view 5 more bullets warfarin indications login to view 1 more bullet Operative inferior vena cava (IVC) filter placement indication login to view 1 more bullet Complications Pulmonary embolism Phlegmasia alba dolens considered a progression from a simple DVT pain, swelling, and pallor from calf all the way up the thigh