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Lower extremity deep vein thrombosis: Symptoms
Last reviewed: 06.07.2025
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Most deep vein thromboses occur in the small veins of the leg and are asymptomatic. When symptoms do occur (eg, vague aching, tenderness along the vein, swelling, erythema), they are nonspecific, vary in frequency and severity, and are similar in the arms and legs. Visible or palpable dilation of collateral superficial veins may be present. Calf discomfort elicited by flexing the ankle with the knee straight (Homans' sign) is sometimes detected in deep vein thrombosis of the distal leg, but it lacks sensitivity and specificity. Leg tenderness, swelling, a difference in circumference of > 3 cm between the legs, mild swelling, and collateral superficial veins may be more prognostically significant. Deep vein thrombosis is likely when three or more of the findings are present and there is no other probable diagnosis. There may be a slight increase in body temperature; occasionally, deep vein thrombosis may cause fever of unknown origin, especially in postoperative patients. If pulmonary embolism develops, symptoms include shortness of breath and pleuritic chest pain.
Common causes of asymmetric leg swelling that mimics deep vein thrombosis include superficial phlebitis, soft tissue trauma, cellulitis, pelvic venous or lymphatic obstruction, and popliteal bursitis (Baker's cyst) that impedes venous return. Abdominal or pelvic tumors are less common causes. Use of drugs that cause tissue swelling (such as dihydropyridine calcium channel blockers, estrogens, and high-dose opioids), venous hypertension (usually due to right ventricular failure), and hypoalbuminemia cause symmetrical bilateral leg swelling. Swelling may be asymmetric if venous insufficiency also develops in the other limb, with one limb being more severe.
Common causes of calf pain that resembles deep vein thrombosis include:
- venous insufficiency and postphlebitic syndrome;
- panniculitis, causing painful erythema of the shin;
- rupture of the popliteal (Baker's) cyst, causing swelling of the lower leg, pain and sometimes bruising in the area of the medial malleolus (pseudo-DVT);
- partial or complete ruptures of tendons.
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