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How is deep vein thrombosis (DVT) diagnosed?

The diagnosis of superficial thrombophlebitis usually is made by the doctor at the bedside of the patient, based upon history, potential risk factors present, and findings from the physical examination. Further risk stratification tools may include scoring systems that can help decide whether a DVT is likely.

If the probability of a DVT is low, a D-dimer blood test may be ordered.

  • If the D-dimer is negative, then it is unlikely that a DVT is the diagnosis.
  • If the D-dimer is elevated, then the possibility of a DVT exists and an imaging study, usually ultrasound, is required to look for the DVT

Ultrasound

  • Ultrasound is the standard method of diagnosing the presence of a deep vein thrombosis.
  • The ultrasound technician may be able to determine whether a clot exists, where it is located in the leg or arm, and how large it is. It also may be possible to know whether the blood clot is new or chronic. If necessary, ultrasounds may be compared over time to see whether a clot has grown or resolved.
  • Ultrasound is better at "seeing" the veins above the knee as compared to the small veins below the knee joint.
  • Clots in the chest or pelvis may not be identified on ultrasound.

D-dimer

D-dimer is a blood test that may be used as a screening test to determine if a blood clot exists. D-dimer is a chemical that is produced when a blood clot in the body gradually dissolves. The test is used as a positive or negative indicator. If the result is negative, then in most cases no blood clot exists. If the D-dimer test is positive, it does not necessarily mean that a deep vein thrombosis is present since many situations will have an expected positive result. Any bruise or blood clot will result in a positive D-dimer result (for example, from surgery, a fall, in cancer or in pregnancy). For that reason, D-dimer testing must be used selectively.

Other tests for DVT

  • Venography, injecting dye into the veins to look for a thrombus, is not usually performed anymore and has become more of a historical footnote.
  • Other blood testing may be considered based on the potential cause for the deep vein thrombosis.
Return to Deep Vein Thrombosis (DVT, Blood Clot in the Legs)

See what others are saying

Comment from: TwiceBittenOnceShy, 35-44 Female (Patient) Published: May 23

In 1990, I was bitten on my arm by a brown recluse spider. My grandmother was dying and I didn't pay attention to the bite for about a week or so. When I noticed it, it was a quarter sized black sore with purple skin out from the center and that skin had cracks in it. Before it got that bad, I tried to pull the scab off, and it wouldn't come off, even with tweezers. When I showed my Mom, she freaked out and took me to a clinic. The doctor immediately knew it was a recluse bite. He gave me a local and cut about two inches of dead tissue. Fast forward to last week, guess what! I have been bitten by a stupid brown recluse again! This time it's on my left arm. I had to wait for my paycheck (one of the many perks of being poor). I went to the emergency room (ER) last night. The wound is smaller than a dime, but it has the slightly sunken necrotic center. The doctor wasn't really surprised (I live in Texas and they aren't uncommon here). I got my prescriptions today. The topical cream was 177 dollars! (Thank you USD 5000 deductible insurance.) I'm glad I was paying attention this time and I will squish any spider I even see again (unless it's a daddy longlegs). The strange thing is, years ago, my Mom was bitten by a recluse. The bite was smaller and she was able to pull the scab off and put hydrogen peroxide on it and within a week, it was just a small scar, never needed to go to the doctor. My dad had the same experience. I guess it affects everyone differently and I'm just lucky this way. The ER visit was USD 350, but I know how dangerous these bites are.

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Comment from: CloseCall, 25-34 Female (Patient) Published: July 08

I was bitten on my heel by a brown recluse spider. Immediately the blister appeared next to the fang marks (one darker than the other), slight swelling, and a strange sensation began. I applied an anti-itch topical cream, iced and elevated my foot for 40 minutes and the swelling and strange sensation subsided. I did not experience any skin breakdown or necrosis. Two days after the bite the blister is gone. Feeling really fortunate.

Was this comment helpful?Yes
Comment from: BettyCrockster, 55-64 Female (Patient) Published: June 03

My background is that I'm an ordinary worker (60 plus hours a week). I woke up one morning in so much overall body pain that I couldn't move, and very cold. I finally made it to the couch, I was swaying back and forth because I was so cold. Then my body temperature went to 'freezing' mode and I started convulsing. I remember grabbing my heart, the pain was unbearable. I stayed like that for 5 days until I was able to drive to work. I thought I had bronchitis or something. I then drove to the clinic and was diagnosed with a heart attack and he directed me to go straight to the hospital. Ambulance service was refused by me. They did blood tests and a CAT scan of my body. They had diagnosed me with pulmonary embolism and pneumonia. I stayed in the hospital for 6 days. My INR was never right but they let me go home due to lack of insurance. Due to lack of insurance I had to stop all treatment after 3 weeks. I am now wondering if the deep vein thrombosis is still there. I know shortness of breath is a concern and I seem to have that.

Was this comment helpful?Yes

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