Clinical Approach to Establishing the Diagnosis

Since the diagnosis of DVT is difficult to establish based solely on history or physical exam, some type of imaging modality is necessary. An appropriate initial imaging study would be either duplex scanning or IPG. The choice is more dependent on local availability and expertise, as both are reasonably accurate, noninvasive, and inexpensive. In patients with risk factors in whom either of these tests are positive, anticoagulation therapy may be initiated if there are no contraindications. If the diagnosis is equivocal or there is potential for false-positive results, either contrast venography or MRI can be performed. A poor IPG study or suspicion of false negative results can be verified by a duplex scan. A good quality duplex scan with adequate compressibility of proximal veins excludes the diagnosis of proximal DVT, but can be repeated in a few days if high clinical suspicion of dVt remains. (There is no evidence that an IPG adds further conformation to a negative duplex scan with good compressibility of the femoral & popliteal vein.) The approach at any given institution is dependent on availability, equipment, and local expertise.

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