Deep vein thrombosis physical examination

Editors-in-Chief: C. Michael Gibson, M.S., M.D. Associate Editor-In-Chief: Ujjwal Rastogi, MBBS [mailto:urastogi@perfuse.org]

Overview
The actual physical signs of venous thrombosis can be quite unreliable. There may be pain and tenderness in the thigh along the course of the major veins

Appearance of the Patient
Obesity may be present.

The patient may complain of lower limb pain.

Vitals
Temperature, Blood Pressure, Pulse and Respiratory rate may all be within normal range.

Extremities
Physical examination may reveal
 * Palpable cord (reflecting a thrombosed vein)
 * Calf or thigh pain
 * Unilateral edema or swelling with a difference in calf diameters, warmth, tenderness and erythema.
 * Superficial venous dilation.

Screening for malignancy
Venous thromboembolism may be the first manifestation of an underlying malignancy. However, a detailed and routine search for an occult malignancy is neither mandatory nor cost effective.

The following test should be considered:

In Males
 * Rectal Examination
 * Fecal occult blood testing (FOBT) must be performed.

In Females
 * Pelvic examinations to rule out any mass/malignancy.