Patients with alternative diagnoses were older, more likely to present with leg swelling, difference in leg circumference and redness than patients without an identifiable alternative diagnosis. In this cohort study of patients negative for acute DVT on whole-leg ultrasound, alternative diagnoses were found in two thirds of the patients with CVI being the most common alternative diagnosis. Therefore, we performed this study to investigate the prevalence, spectrum and predictors of alternative diagnosis explaining leg symptoms among patients evaluated with whole-leg ultrasound for suspected DVT. Hence, evaluation for alternative diagnoses using whole-leg ultrasound in patients with negative acute DVT scans may enhance the overall quality of patient care as well as patients’ and health care providers’ satisfaction. Many alternative diagnoses such as chronic venous insufficiency (CVI) or soft tissue inflammation require specific treatment and it would be prudent to not miss these diagnoses during the initial work-up. For both health care providers and patients, it can be unsatisfactory to rule out DVT and discharge the patient without identifying a cause for the patient’s symptoms. However, most of these patients had signs or symptoms that led to the clinical suspicion of acute DVT. In most cohort studies, the majority of focused ultrasound examinations for DVT in patients with suspected acute DVT are negative (56 to 77%). The major advantage of this approach, in addition to detection of isolated calf DVT, is that it allows to identify alternative diagnoses which may have caused the patient’s leg symptoms, thereby mimicking acute DVT. We prefer to perform a whole-leg ultrasound in all patients with suspected acute DVT in our institution, conforming to current multidisciplinary guidelines. Some centers choose to perform a limited compression ultrasound examination as the initial test focusing primarily on the femoral and popliteal veins. Duplex ultrasound of the lower extremity has therefore become the standard radiological screening test for patients with suspected acute DVT. Clinical signs and symptoms of DVT are often vague and laboratory D-dimer tests, routinely used for DVT screening, tend to have low specificity. Therefore, accurate diagnosis and prompt initiation of anticoagulant therapy is important to reduce morbidity. The Creative Commons Public Domain Dedication waiver ( ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.Īcute deep venous thrombosis (DVT) is a common condition for which patients seek emergency medical care and is associated with pulmonary embolism as a potentially life-threatening complication. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made.
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