Deep Vein Thrombosis of the Lower Extremities: Symptoms
Last reviewed: 23.04.2024
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Most deep venous thrombi occur in small veins of the lower leg, they are asymptomatic. When symptoms appear (for example, indeterminate aching pain, tenderness along the veins, edema, erythema), they are nonspecific, vary in frequency and severity and are the same in the hands and feet. Perhaps a visible or palpable widening of the collateral surface veins. Discomfort in the lower legs, when bending the leg in the ankle joint with a straightened knee (Homens symptom), is sometimes found in deep venous thrombosis of the distal segments of the foot, but it does not have sensitivity and specificity. Soreness of the leg, its swelling, a difference in circumference> 3 cm between the shins, soft edema and collateral superficial veins can be more prognostically significant. Deep venous thrombosis is possible with a combination of three or more symptoms in the absence of another probable diagnosis. There may be a slight increase in body temperature; sometimes deep venous thrombosis can be the cause of fever of unknown origin, especially in post-operative patients. With the development of pulmonary embolism, symptoms include shortness of breath and pleural pain in the chest.
Frequent causes of asymmetric foot swelling imitating deep venous thrombosis are superficial phlebitis, soft tissue trauma, cellulitis, pelvic venous or lymphatic vessel obstruction, and poplite bursitis (Baker's cyst), which complicates venous outflow. Abdominal or pelvic tumors are more rare causes. The use of drugs that cause tissue swelling (such as dihydropyridine calcium channel blockers, estrogens, high-dose opioids), venous hypertension (usually due to right ventricular failure) and hypoalbuminemia cause symmetrical bilateral edema of the legs. The swelling may be asymmetrical if venous insufficiency develops in another limb, and in one of them it has a more severe course.
Frequent causes of pain in the lower leg, similar to the manifestations of deep venous thrombosis, are as follows:
- venous insufficiency and post-phlebitis syndrome;
- panniculitis, which causes painful erythema of the lower leg;
- rupture of the popliteal cyst (Baker), causing swelling of the lower leg, pain and sometimes bruising in the medial malleolus (pseudo-GWT);
- partial or complete ruptures of tendons.
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