What are the signs of Deep Vein Thrombosis (DVT)?

Signs of Deep Vein Thrombosis (DVT)

The most common signs of Deep Vein Thrombosis (DVT) include pain, swelling, erythema (redness), and tenderness in the affected extremity, with symptoms typically worsening with prolonged standing or walking and improving with rest or limb elevation. 1

Primary Clinical Manifestations

Lower Extremity DVT Signs

• Pain and tenderness in the affected limb, often described as a deep tension, heaviness, or feeling of dead weight 1
• Unilateral swelling or edema of the affected extremity 1
• Erythema or redness of the skin over the affected area 1
• Warmth of the skin over the thrombosed vein 1
• Dilated superficial veins (collateral circulation) 1
• Symptoms typically worsen with prolonged standing or walking and improve with rest or limb elevation 1

Upper Extremity DVT Signs

• Ipsilateral upper extremity swelling and pain 1
• Cervical edema 1
• Dilation of superficial collateral venous circulation 1

Advanced or Severe Presentations

• Phlegmasia coerulea dolens (severe form) - characterized by painful blue discoloration of the limb 2
• Venous claudication - bursting leg pain during exercise that can resemble arterial claudication, often associated with iliofemoral or popliteal vein thrombosis 1
• Post-thrombotic syndrome - chronic manifestations including:
  • Persistent edema 1
  • Hyperpigmentation of the skin 1
  • Lipodermatosclerosis (hardening of the skin) 1
  • Venous ulceration in severe cases 1

Important Clinical Considerations

• Approximately one-third of patients with DVT do not have any symptoms, making clinical diagnosis challenging 1
• Symptoms are often not apparent until there is involvement above the knee 1
• DVT that is limited to infrapopliteal calf veins (below-the-knee or distal DVT) may have milder symptoms but can extend proximally in approximately one-sixth of cases 1
• Above-the-knee or proximal DVT is strongly associated with increased risk for pulmonary embolism 1

Differential Diagnosis

• Baker's cyst (popliteal cyst) 1
• Cellulitis 1
• Lymphedema 1
• Chronic venous disease 1
• Musculoskeletal disorders 1

Diagnostic Approach

• Clinical assessment alone is insufficient for diagnosis, with only about 30% of patients with clinically suspected DVT having the diagnosis confirmed by objective testing 3
• Diagnostic algorithms combining pretest probability (Wells score), D-dimer testing, and compression ultrasound imaging are recommended for suspected lower-extremity thrombosis 4
• In cancer patients, proceeding directly to compression ultrasonography for suspected DVT is recommended without using clinical prediction rules and D-dimer testing 1

Pitfalls and Caveats

• Relying solely on clinical signs and symptoms can lead to missed diagnoses, as many patients with DVT are asymptomatic 1
• DVT symptoms can be nonspecific and may mimic other conditions 1
• Superficial vein thrombosis (SVT) can occur simultaneously with DVT and predisposes patients to DVT 1
• An extensive SVT in the saphenous vein can progress to involve the deep venous system at the saphenofemoral junction, potentially leading to pulmonary embolism 1
• In patients with recurrent DVT symptoms, distinguishing between new thrombosis and post-thrombotic syndrome can be challenging 3