Deep Vein Thrombosis

Deep Vein Thrombosis

It is thrombosis of part or all deep venous system of extremities.

Predisposing factors:-

Virchaw's triad :-

1) Abnormal blood flow.

2) Abnormal constituent.

3) Abnormal blood wall.

1) Abnormal blood flow:-

@immobilization. (Fracture, trauma, driver long standing, pregnancy, paralysis, postoperative)

@ Heart failure.( CVA , MI , CHF )

(These tows are the most important)

@ Compression of vein by trauma.

@ Causes of loss of fluid and dehydration (hypovolemic shock).

2) Abnormal constituent:-

@ Contraceptive.

@ Thrombocytosis.

@ Protein C & S deficiency.

@ Anti thrombin III deficiency. (Acquired deficiency of anti thrombin III occur in nephritic syndrome)

@ polycythemia , leukemia , lymphoma .

@ SCA .

@ paraproteinemia.

@ abnormal Hbc

@ Malignancy (mostly : pancreas , lung , and prostate ).

@ Antiphospholipid syndrome, present in SLE patient.

3) Abnormal blood wall:-

@ Trauma of vein (during IV line, surgery)

@ Drug abuser.

@ Vascullitis (primary or secondary to CT disease).

@ H / O varicose vein.

@ H/O thrombophilitis.

NB:-

In any DVT patient ask about:-

Trauma, occupation , travel , immobilization , heart disease .

Differential diagnosis:-

Swelling of one leg:

- DVT.

-Cellulites.

- Lymphoma.

- Rupture of picker's cyst.

- Hematoma.

Complications:-

@ Pulmonary embolism and infarction. (Most important)

@ Post pheleptic syndrome.

Investigation:-

( Not in order)

@ The most diagnostic vienogram and dopllar ultrasound (dopllar most important)

@ CBC : for polycythemia-------- increase ESR

@ AVG for pulmonary embolism.

@ Chest X –ray to exclude lung disease.

@ ECG to detect pulmonary embolism. ( S1Q3T3 classical sign for PE)

@ Immunoelectrophoresis for paraproteinemia.

@ PT , PTT for proteinC , S and antithrombinIII level.

@ Tumor markers.

@ Antiphospholipid antibodies.

@ Antinuclear antibodies for CT disease.

@ Abdominal US to look to mass in abdomen cause compression.