The following classical signs and symptoms appear in the lower limbs of around 50% of the patients with deep vein thrombi [7] [8].

• Swelling of the leg
• Pain or tenderness which may be associated with walking or standing
• Erythema or discolored skin
• Dilated superficial veins
• Low grade fever with increased pulse
• Calf tenderness

Phlegmasia alba dolens (white leg): This condition is characterized by pain, pitting edema and blanching. There is no associated cyanosis. The condition occurs because of obliteration of the major deep venous channels with relative sparing of collateral veins. As a result, swelling occurs but there is no cyanosis.

Phlegmasia cerulea dolens (Blue leg): The condition occurs when the thrombi involve the deep veins as well as the collateral channels. Thus all the venous outflow is blocked and there is massive fluid sequestration and significant edema. The affected limb in phlegmasia cerulea dolens is extremely painful, edematous and cyanotic and may be associated with arterial insufficiency and compartment syndrome. If untreated venous gangrene ensues which may even require amputation.

Signs

• Homan’ s Test: Forcible dorsiflexion of foot results in severe pain in the calf region. It is not used commonly now.
• Moses Test: In this test, tenderness over the calf muscles is elicited on squeezing the muscle from side to side. Ideally, it should not be performed as there is risk of embolization.

• Pain

  When reaching the lungs this clot (now referred to as an embolus) causes pain and shortness of breath. [thrombosisplace.ca]

  […] may be warmer than usual Skin that is red or discolored The veins near the skin’s surface may be larger than normal Symptoms of a pulmonary embolism include: Sudden shortness of breath or fast breathing Sharp chest pain that often comes with coughing [my.clevelandclinic.org]

  Pain and swelling in the leg are common symptoms. Post-thrombotic syndrome may also happen following a blood clot in a leg vein. It is a long-term problem with pain, swelling, and redness. Ulcers and sores can also happen. [radiology.ucla.edu]

  One week later he presented to our emergency department with acute sudden increase in the pain and swelling of his left knee, and pain and swelling of his left leg, without any trauma. [ncbi.nlm.nih.gov]

• Swelling

  Pain and swelling in the leg are common symptoms. Post-thrombotic syndrome may also happen following a blood clot in a leg vein. It is a long-term problem with pain, swelling, and redness. Ulcers and sores can also happen. [radiology.ucla.edu]

  In other people, if a deep leg vein is involved, the calf swells and may be painful, tender to the touch, and warm. The ankle, foot, or thigh may also swell, depending on which veins are involved. [merckmanuals.com]

  Some symptoms include: leg swelling pain and changes in skin coluration. Recognizing DVT symptoms and VTE could be the key to getting the care you need and saving your life. [thrombosisplace.ca]

  One week later he presented to our emergency department with acute sudden increase in the pain and swelling of his left knee, and pain and swelling of his left leg, without any trauma. [ncbi.nlm.nih.gov]

  The clot can block blood flow and cause swelling and pain. When a clot breaks off and moves through the bloodstream, this is called an embolism. An embolism can get stuck in the brain, lungs, heart, or other area, leading to severe damage. [texashealth.org]

• Leg Swelling

  Most DVTs are asymptomatic; however, there may be asymmetrical leg swelling, unilateral leg pain, dilation or distension of superficial veins, and red or discoloured skin. [bestpractice.bmj.com]

  A previously healthy 6-month-old male was brought to the emergency department by his family with a chief complaint of left leg swelling. Duplex ultrasonography in the emergency department revealed multiple DVTs in the leg vasculature. [ncbi.nlm.nih.gov]

  This condition is characterized by pooling of blood, chronic leg swelling, increased pressure, increased pigmentation or discoloration of the skin, and leg ulcers known as venous stasis ulcers. [my.clevelandclinic.org]

  If you do experience symptoms, they may include: Leg pain or tenderness in calf muscles Leg swelling Changes in skin color on the leg or foot Symptoms of a pulmonary embolism include: Chest pain Shortness of breath Rapid pulse Cough Diagnosis & Treatment [heart.uvahealth.com]

• Fever

  Evidently, patients with dengue fever who have prolonged fever (more than 5 days) and acute kidney injury are at high risk for concurrent bacteremia. [ncbi.nlm.nih.gov]

• Congestive Heart Failure

  If you have heart failure, you are at increased risk for DVT and pulmonary embolism due to limited heart and lung function. Being overweight or obese increases the pressure in the veins of your legs and pelvis, raising the risk of clots. [everydayhealth.com]

  Lixiana is indicated in prevention of stroke and systemic embolism in adult patients with nonvalvular atrial fibrillation (NVAF) with one or more risk factors, such as congestive heart failure, hypertension, age ≥ 75 years, diabetes mellitus, prior stroke [fi.health-root.com]

  Also, there are specific medical conditions that may increase your risk of developing a DVT via these three mechanisms, such as congestive heart failure, severe obesity, chronic respiratory failure, a history of smoking, varicose veins, pregnancy and [vascularcures.org]

• Respiratory Distress

  The differential diagnosis includes acute respiratory distress syndrome (ARDS), aspiration, atelectasis, heart failure, pneumonia, and systemic infection. [web.archive.org]

• Nausea

  She present swell at knee and calf from postoperative 3 weeks, and developed dyspnea, palpitation, and nausea on 33th day, pulmonary embolism was confirmed with CT angiography at emergency department. [ncbi.nlm.nih.gov]

  The signs and symptoms of heart attack include: chest pain, upper abdominal pain, arm, neck, or jaw pain, indigestion, shortness of breath, sweating, nausea, and others. [emedicinehealth.com]

  Aside from bleeding-related issues, there are several side effects that have been linked to blood thinners, such as nausea and low counts of cells in your blood. [fi.health-root.com]

  […] that horse chestnut seed extract is efficacious for the short-term treatment of symptoms of chronic venous insufficiency such as leg pain and edema and that adverse events were mild and infrequent and included gastrointestinal complaints, dizziness, nausea [web.archive.org]

• Vomiting

  Signs of excessive bleeding can include prolonged nose bleeds, severe bruising, bleeding gums, vomiting or coughing up blood, and, for women, increased bleeding during menstruation. [natfonline.org]

  Bleeding in your belly can cause pain, vomit that's red or looks like coffee grounds, and bright red or black stools. Bleeding in your brain can bring on severe headaches, vision changes, unnatural movements, and confusion. [onhealth.com]

  Symptoms of pulmonary embolism include: Shortness of breath Sudden onset of chest pain Coughing Spitting up or vomiting blood If your doctor suspects DVT, he or she will order diagnostic tests. Tests Duplex ultrasound. [orthoinfo.aaos.org]

  It is important not to take aspirin, unless you know you are safe to do so and have had no previous problems with vomiting blood or peptic ulcers. [anzsvs.org.au]

• Venous Insufficiency

  The two most common complications of a blood clot are chronic venous insufficiency and post-thrombotic syndrome. Chronic venous insufficiency may happen following a blood clot in a leg vein. It means that a vein no longer works well. [radiology.ucla.edu]

  [ 11, 17 ], and the Chronic Venous Insufficiency Questionnaire (CIVIQ [ 14 ]). [hqlo.biomedcentral.com]

  In either case this may cause problems in the legs in the future (see chronic venous insufficiency). [anzsvs.org.au]

  DVT can also lead to complications in the legs referred to as chronic venous insufficiency or the post-thrombotic syndrome. [my.clevelandclinic.org]

• Homans' Sign

  Of those who responded, 80.5% were taught to use Homans sign to screen for a possible DVT in their entry-level education and 67.9% continued to use Homans sign in clinical practice. [ncbi.nlm.nih.gov]

  Signs and symptoms of a DVT are: redness, swelling, warmth of surrounding skin, and positive Homan's Sign. A DVT can be diagnosed through an ultrasound or d-dimer test. [youtube.com]

  Homan's Sign Homan's Sign has been used as an indicator for LE DVT since the 1940s. [12] The test is performed by forcefully dorsiflexing the ankle while the knee is extended. Pain and tenderness in the calf is said to be indicative of LE DVT. [physio-pedia.com]

• Tachycardia

  Signs of PE include: Chest pain Coughing up blood Rapid heart rate (tachycardia) of more than 100 beats per minute Shortness of breath Diagnosis of Deep Vein Thrombosis To diagnose DVT, your doctor will ask you about your symptoms. [rwjbh.org]

  When symptoms do occur, they may include: swelling in the leg red, discolored, or white skin a cord in a leg vein that can be felt rapid heart beat (tachycardia) slight fever warm skin more visible surface veins dull ache, tightness, tenderness or pain [surgery.med.miami.edu]

  Electrocardiography shows sinus tachycardia. Chest radiography shows small atelectatic changes at the left lung base ( Figure 1 ). Pulmonary embolism is suspected, and a serum Ddimer level is obtained; it is 4,054 ng/mL (reference range < 500). [doi.org]

  […] hypertension, heart disease, and stroke are related What causes high blood pressure and how to know if you have hypertension How to lower blood pressure with a heart-healthy diet and exercise What is a good resting heart rate, for adults and kids What is tachycardia [insider.com]

• Hydrops Fetalis

  Hydrops fetalis is a condition in a baby characterized by an accumulation of fluid in at least two body compartments. Cause[edit] Heart[edit] The pumping force of the heart should help to keep a normal pressure within the blood vessels. [en.wikipedia.org]

• Skin Discoloration

  Signs or symptoms of postphlebitic syndrome may include: Leg aching and fatigue Aching Swelling Hyperpigmentation or skin discoloration Itching and dry skin of the affected leg The hyperpigmentation or skin discoloration is caused by the breakdown of [umcvc.org]

  The scale queries patients on the following symptoms: leg pain, swelling, leg-related sleep problems, skin discoloration, cosmetic appearance, activity limitation, and emotional distress. [hqlo.biomedcentral.com]

  Signs and symptoms of post-thrombotic syndrome include: Swelling or pain in your legs Skin discoloration Skin sores Finally, pulmonary hypertension (elevated blood pressure in your pulmonary artery) is a rare complication of pulmonary embolism. [everydayhealth.com]

  Damage to your veins from the blood clot reduces blood flow in the affected areas, which can cause: Persistent swelling of your legs (edema) Leg pain Skin discoloration Skin sores Prevention Measures to prevent deep vein thrombosis include: Avoid sitting [mayoclinic.com]

• Erythema

  On physical examination, the patient had increased warmth, edema, erythema, and tenderness in the left calf, with positive Homan's sign. A lower-extremity venous Doppler was negative for DVT. [ncbi.nlm.nih.gov]

  […] doctor immediatrly if you have any of the following signs or symptoms: Edema (swelling) of the leg or along a vein in the leg Pain and tenderness in the leg, which you may only feel when standing or walking Warmth in the swollen area of the leg Fever Erythema [ksi.uconn.edu]

  PICC line and upper limb DVT) 6 In the lower limbs, patients often present with unilateral leg pain, swelling, and erythema. On physical examination, the affected leg is often tender and warm, and there may be dilation of superficial veins. [radiopaedia.org]

  Swelling of the leg Pain or tenderness which may be associated with walking or standing Erythema or discolored skin Dilated superficial veins Low grade fever with increased pulse Calf tenderness Phlegmasia alba dolens (white leg): This condition is characterized [symptoma.com]

• Warm Skin

  You may notice redness or warm skin at the affected part. [diabetes.co.uk]

  The technician spreads warm gel on your skin and then rubs a wand over the area where he thinks the clot could be. [webmd.com]

  DVT symptoms and when to seek help Common symptoms of deep vein thrombosis include pain, swelling, red and warm skin, and tenderness in the affected area – usually the calf or thigh. Some people won’t experience symptoms. [health.qld.gov.au]

  They may include: Pain, especially deep in the muscle Swelling Aching or tenderness Red or warm skin Fever Call your healthcare provider if you have these symptoms. [fairview.org]

• Flushing

  […] pacemakers, or injection drug use Upper extremity DVT occasionally occurs as part of superior vena cava (SVC) syndrome (compression or invasion of the superior vena cava by a tumor and causing symptoms such as facial swelling, dilated neck veins, and facial flushing [merckmanuals.com]

  It should be administered slowly over 5 to 10 minutes; rapid infusion can cause shortness of breath, flushing, bradycardia, hypotension, or anaphylaxis. [web.archive.org]

• Leg Pain

  We report a case of a patient presenting with acute leg pain resembling that of a deep vein thrombosis, and a beginning leg compartment syndrome following a suspected ruptured Baker's cyst. [ncbi.nlm.nih.gov]

  Symptoms Deep vein thrombosis signs and symptoms can include: Swelling in the affected leg. Rarely, there's swelling in both legs. Pain in your leg. The pain often starts in your calf and can feel like cramping or soreness. [mayoclinic.com]

  Some sudden signals that DVT may be present include: Swelling in one leg (and rarely in both legs) Pain, tenderness, or a feeling of cramping in the leg A warm feeling on the skin of the leg Reddish skin on the leg Visible veins on the leg Weak or tired [arteryandvein.com]

• Calf Pain

  The most common symptoms of DVT are calf pain and swelling. It is well established that patients with these symptoms may not have a DVT and that patients with a DVT may have few symptoms. The first presentation might be of a pulmonary embolism. [canadianvascular.ca]

  PTS can involve chronic leg swelling, calf pain, calf heaviness/fatigue, skin discoloration, and/or venous ulcers. What is pulmonary embolism (PE)? A pulmonary embolism is a blood clot that has traveled to the lungs. It often starts as a DVT. [natfonline.org]

  Shutterstock So now you’ve got phantom calf pain and you’re convinced you can’t breathe, right? Believe us, we get it. [bicycling.com]

  This can affect the tissues of your calf and lead to symptoms, including: calf pain swelling a rash ulcers on the calf (in severe cases) When a DVT develops in your thigh vein, there's an increased risk of post-thrombotic syndrome occurring. [nhsinform.scot]

• Leg Discoloration

  PTS consists of chronic leg pain (aching or cramping), leg heaviness, itching or tingling, swelling, redness, varicose veins and leg discoloration. [medstarwashington.org]

• Dizziness

  Symptoms of a pulmonary embolism include: Sudden shortness of breath or fast breathing Sharp chest pain that often comes with coughing or movement Pain in the back Cough (sometimes with bloody sputum/phlegm) Sweating more than normal Fast heartbeat Feeling dizzy [my.clevelandclinic.org]

  The warning signs and symptoms of a pulmonary embolism include: Sudden shortness of breath Chest pain or discomfort that worsens when you take a deep breath or when you cough Feeling lightheaded or dizzy, or fainting Rapid pulse Coughing up blood Causes [mayoclinic.com]

  […] of breath Chest pain Weakness and dizziness Death Chronic venous insufficiency keeps blood from flowing smoothly through the damaged vein. [merckmanuals.com]

• Confusion

  The clinical signs can be confused with the onset of post-thrombotic syndrome. For these reasons, diagnosis of DVT recurrence must rely on an accurate method. [ncbi.nlm.nih.gov]

  Bleeding in your brain can bring on severe headaches, vision changes, unnatural movements, and confusion. Call 911 or go to the emergency room if you notice any of these symptoms. [onhealth.com]

The investigations that are necessary to diagnose deep vein thrombosis include:

• Duplex ultrasound: Duplex ultrasound is the test of choice to diagnose deep vein thrombosis as it is non-invasive, hazard-free and reliable.
• Contrast venography: Radio-opaque dye is injected into dorsal venous arch and an x-ray radiograph is taken. A clot if present appears as a filling defect.
• Blood tests: People with severe deep vein thrombosis have an elevated level of a clot-dissolving substance called D-dimer. Many inherited and acquired causes of hypercoagulability such as anti-thrombin III, protein C or protein S deficiency can also be detected by blood test.
• CT scan or MRI scans: These investigations are helpful as they can provide visual images of veins and may show a clot.

The treatment options for deep vein thrombosis include the following.

• Elevation of limb: This is essential to regulate unidirectional flow of blood.
• Compression stockings: These help prevent the swelling associated with deep vein thrombosis. These are worn on the legs from feet to above the level of knees.
• Filters: A filter may be inserted into a large vein (such as the vena cava) that prevents clots that break loose from lodging into lungs [9].
• Blood thinners: The anticoagulants used to treat deep vein thrombosis include heparin and warfarin. Intravenous heparin is given according to weight of patient. Generally 10,000 units intravenous bolus with continuous infusion of 30,000 to 45,000 units per day is given. Warfarin is started 2-3 days before withdrawal of heparin because of its slow onset of action.
• Venous thrombectomy: Thrombus can be removed by opening the femoral vein via incision in the groin.
• Thrombolysis: This is a modern technique. Catheter is passed in the vein and streptokinase is infused locally to cause thrombolysis [10].

Many individuals who have a first episode of deep vein thrombosis will have a recurrent event. The risk of recurrence may be reduced by the use of compression stockings. Untreated cases of deep vein thrombosis can lead to pulmonary embolism which is one significant causes of death in these patients [6].

The various factors responsible for deep vein thrombosis include the following:

• Trauma: This leads to the injury to vessel wall. A broken hip or leg and subsequent surgeries are the common causes for the development of venous thrombi [1].
• Hormones: Oral contraceptive pills and the current use of hormone therapy especially in postmenopausal women can contribute to this condition.
• Road traffic accidents: Accidents causing trauma can also reduce blood flow to any part of the body leading to thrombosis.
• Operations: Surgical procedures such as cholecystectomy and splenectomy can be a common cause of deep vein thrombosis.
• Malignancy: People with cancer or a malignant mass have an increased risk for the development of deep vein thrombosis.
• Blood disorders: Conditions such as thrombophilia that cause the blood to clot more easily than normal can increase the risk [2] [3].
• Obesity: Obesity, especially in older people over 60 years of age, is closely linked with the development of deep vein thrombosis.
• Stroke: Conditions like stroke and heart failure increase the risk of deep vein thrombosis.
• Immobilization: Any illness or injury that causes immobility predisposes the person to the formation of deep vein thrombi [4]. Long travel is often a risk factor [5].
• Male gender: Deep vein thrombosis is more common in men as compared to women.

Deep vein thrombosis is more common in men than in women. The incidence is four times higher in the elderly over the age of 60 years.

In the United States, it is estimated that about 1 in 1,000 people have a deep vein thrombosis each year. On average, one in every 20 people develops deep vein thrombosis at least once in the course of his or her lifetime.

The pathophysiology of thrombus formation in deep vein thrombosis is explained by Virchow’s triad.

• Endothelial injury: Endothelial damage in the blood vessel that may be intrinsic or due to external trauma leads to rupture of the vessel wall. This reduces the blood flow to a particular part, which activates certain biochemical pathways, leading to thrombus formation. The factors causing endothelial injury include hypertension, endotoxin, trauma, smoking and antiphospholipid syndrome.
• Venous stasis: Certain conditions like cardiac arrhythmias, aneurysms and prolonged period of rest after surgery lead to stasis or turbulence of blood flow. Lack of motion can cause sluggish blood flow causing thrombus formation.
• Blood hypercoagulability: Blood may become thick and clot easily in certain inherited conditions like antithrombin III deficiency and protein C or S deficiency. Hormone therapy and birth control pills also can increase the risk of clot formation.

Deep vein thrombosis can be prevented by ensuring of a healthy life style, proper diet and regular exercise. Long periods of immobility must be avoided after major surgical procedures or on long travels.

People who are overweight must reduce their weight to prevent the risk of deep vein thrombosis. Regular checking of blood pressure with plenty of fluids intake and avoid smoking may also help prevent the risk of deep vein thrombosis.

Deep vein thrombosis is a condition in which there is formation of blood clots in the deep veins. These blood clots are known as thrombi and they can form in veins anywhere in the body; however, the large veins in legs and thighs are most frequently involved.

The condition is characterized by swelling, pain and tenderness, often in the legs. Risk factors for the formation of thrombi include immobility, hormone therapy and pregnancy. Deep vein thrombosis are most common in the elderly over 60 years of age; however, no age is immune.

A thrombus in a deep vein can break off and travel to lungs through bloodstream, leading to pulmonary embolism.

Deep vein thrombosis is a blood clot that usually forms in the deep veins of the lower leg and thigh. The patients usually develop swelling and pain of the leg and changes in the color of the overlying skin. Sitting for long periods when travelling can increase the risk of deep vein thrombosis. With proper medications and regular exercise, the disease has a good prognosis.

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