PULMONARY EMBOLISM-DVT
SUMMARY
1. Duplex ultrasonography combines real-time, B-mode ultrasonography, which visualizes the vessel with Doppler flow detection, looking for compressibility of vessel and flow.
2. This test is reliable only in symptomatic patients being evaluated for their 1st DVT by an experienced operator (operator-dependent); 93% sensitive, 98% specific.
3. It is poor for detecting distal DVT (because the vessels are hard to visualize) and abdominopelvic thrombi (from which most cases of PE arise), in these cases use high resolution CT.
4. Phlegmasia cerulea dolmens: extensive DVT with oedema resulting in vascular insufficiency. Surgical emergency requiring urgent intervention: thrombolytics/thrombectomy.
5. Below-knee DVTs only require surveillance, above-knee requires treatment. Migration above-knee causes pain. Hence, decision to treat depends on risk factors & pain.
Reference(s)
Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].
