From the Research
Deep vein thrombosis (DVT) and acute compartment syndrome (ACS) of the lower leg are two distinct clinical entities that present with different features, despite both causing leg pain, and require prompt diagnosis and treatment to prevent morbidity and mortality. DVT typically presents with unilateral leg swelling, warmth, redness, and pain that worsens with standing or walking, as noted in various studies 1, 2. The pain is often described as a dull ache or heaviness, and patients may have risk factors such as immobility, recent surgery, or hypercoagulable states. Homans' sign (calf pain with dorsiflexion) may be positive. In contrast, acute compartment syndrome presents with severe, progressive pain out of proportion to the injury, often described as deep, constant, and unrelieved by normal analgesics, as highlighted in studies 3, 4, 5. The affected compartment feels tense and firm on palpation. The hallmark "5 P's" include pain, paresthesia (numbness/tingling), pallor, pulselessness, and paralysis, though the latter signs appear late.
Key Differences in Clinical Presentation
- DVT: unilateral leg swelling, warmth, redness, pain worsening with standing or walking, risk factors such as immobility or hypercoagulable states
- ACS: severe, progressive pain out of proportion to the injury, tense and firm compartment on palpation, "5 P's" (pain, paresthesia, pallor, pulselessness, paralysis) ACS is typically associated with trauma, crush injuries, or fractures, and requires immediate surgical fasciotomy to prevent permanent tissue damage, as emphasized in studies 1, 3, 5. DVT management involves anticoagulation (heparin followed by warfarin or direct oral anticoagulants), while ACS is a surgical emergency requiring prompt compartment pressure measurement and fasciotomy if pressures exceed 30 mmHg or are within 30 mmHg of diastolic pressure. The timing of intervention differs significantly—DVT treatment can begin within hours, while ACS requires intervention within 6 hours to prevent irreversible muscle and nerve damage, as noted in studies 3, 4.
Importance of Prompt Diagnosis and Treatment
- Delayed diagnosis and treatment of ACS can lead to irreversible muscle and nerve damage, limb amputation, and even death, as highlighted in studies 1, 3, 5
- Prompt recognition and treatment of DVT can prevent pulmonary embolism and other complications, as noted in studies 1, 2 Therefore, it is crucial to prioritize the diagnosis and treatment of ACS over DVT in patients presenting with severe leg pain and swelling, and to consider the potential for both conditions to coexist, as noted in study 1.