Deep Vein Thrombosis and Pulmonary Thromboembolism - Presentation, Investigation and Therapy

Question 1

Describe the presentation of deep vein thrombosis

Answer 1

SYMPTOMS
- Unilateral limb swelling
- Persisting discomfort
- Calf tenderness

SIGNS
- Warmth
- Redness - erythema
- Prominent collateral veins
- Unilateral pitting oedema

MAY BE CLINICALLY SILENT

Question 2

Describe the presentation of pulmonary thromboembolism

Answer 2

PULMONARY EMBOLISM
- Pleuritic chest pain
- S.O.B. - dyspnoea
- Blood in sputum - haemoptysis
- Tachycardia
- Pleural rub on auscultation

MASSIVE PULMONARY EMBOLISM
- severe dyspnoea of sudden onset
- Collapse
- Cyanosis (Blue lips and tongue)
- Tachycardia
- Hypotension
- Raised jugular venous pressure
MAY CAUSE SUDDEN DEATH

Question 3

Describe the investigation of deep vein thrombosis

Answer 3

• Wells score
• Blood test
• Imaging: compression ultrasound

Question 4

Describe the investigation of pulmonary thromboembolism

Answer 4

• Well score
• Clinical assessment
• Blood test
• Imaging: CT pulmonary angiogram

Question 5

Describe the management of deep vein thrombosis

Answer 5

• Vascular surgical intervention in MASSIVE DVT

Question 6

Describe the management of pulmonary thromboembolism

Answer 6

• Anticoagulation
• Warfarin
• Thrombolysis for MASSIVE PE