Clinical Presentation

Signs and symptoms of DVT may include unilateral leg swelling, pain, warmth, and erythema. However, up to half of DVT cases may be asymptomatic.

Risk factors for VTE in hospitalized patients include:

• Older age (over 40 years old)
• Obesity
• Active cancer or cancer therapy
• Personal or family history of VTE
• Estrogen therapy
• Pregnancy and postpartum period
• Lower extremity trauma or recent surgery
• Prolonged immobility
• Critical illness
• Chronic cardiopulmonary disease
• Nephrotic syndrome
• Inflammatory bowel disease
• Inherited or acquired thrombophilia
• Central venous catheter

The most common sites of DVT formation are in the deep veins of the lower extremities, including the femoral, popliteal, and calf veins. Upper extremity DVT may occur with central venous catheters.

Clinical diagnosis of DVT lacks sensitivity and specificity. Only about 50% of confirmed DVT cases present with classic signs like unilateral leg swelling, pain, and positive Homan’s sign (calf pain on dorsiflexion). Objective testing is required for accurate DVT diagnosis.

Contrast venography is the gold standard for DVT diagnosis but is rarely used now due to its invasive nature. Compression ultrasound is the preferred initial test for suspected lower extremity DVT.