(Deep Venous Thrombosis)
Incidence :
The true incidence of blood clots in
legs is not exactly known as many cases pass unnoticed, however 10% of
patients who die in hospital ,the cause of death is pulmonary embolism
following blood clots in legs.
Etiology
virchow's triad
:Pathology
*Blood clots in legs & obstruction lead to increase in distal venous pressure lead to local edema.
*If the venous pressure becomes more than local arterial pressure lead to blood flow ceases and finally Venous gangrene
*The viens may be fibrosed "if small" or recanalize "if large" but ,the valves are permanently destroyed ,the end result is Chronic venous insufficiency.
*blood clots in legs may detach and lead to Pulmonary embolism.
Clinical Picture :
1-Asymptomatic Group
*Most cases are silent.
*The first presentation may be pulmonary embolism or postphleptic limb.
*Suspected by unexplained fever and tachycardia.
*If the venous pressure becomes more than local arterial pressure lead to blood flow ceases and finally Venous gangrene
*The viens may be fibrosed "if small" or recanalize "if large" but ,the valves are permanently destroyed ,the end result is Chronic venous insufficiency.
*blood clots in legs may detach and lead to Pulmonary embolism.
Clinical Picture :
1-Asymptomatic Group
*Most cases are silent.
*The first presentation may be pulmonary embolism or postphleptic limb.
*Suspected by unexplained fever and tachycardia.
2-Classical Picture :
^General :
*Mild unexplained fever.
*Tachycardia out of propotion to fever (lysis of blood clots in legs lead to release of pyrogens &toxins )
^Local :
*Classical traid of pain ,swelling ,tenderness .
*Depends upon the site of the of clot.
1-Pain :there is usually aching discomfort and tightness in the involved calf or thigh ,which are aggravated by muscular exercise .
2-Swelling :(it is the most reliable physical sign )
-In calf thrombosis .......swelling is limited to foot and ankle.
-In femoral thrombosis .....swelling involves calf and lower part of thigh.
-In iliofemoral thrombosis .....swelling affects whole leg.
3-Tenderness :present on grasping the affected leg.
NB: Although I hope from you to stay long time on my blog ,but you shoud know that blood clots in legs occurring in sitting on computer for prolonged time.
Homan sign :
*Pain is felt in calf on dorsiflexion of foot ,it is not reliable sign as it may be falsely positive in cases of muscle contusion or celllulitis.
a-General : Pulmonary embolism
b-Local ;
1-Early ;
*Phlegmaasia alba dolens :massive blood clots in legs may be associated with severe arterial spasm and lymphangitis ,so the leg become pale , white and massively swollen with absent peripheral pulsation .
*Phlegmasia cerulae dolens : massive blood clots in legs may be associated with severe congestion and cyanosis and whole leg looks massively swollen and blue and if not probably treated , it may lead to venous gangrene.
2-Late :
*Post phlebitic leg
^General :
*Mild unexplained fever.
*Tachycardia out of propotion to fever (lysis of blood clots in legs lead to release of pyrogens &toxins )
^Local :
*Classical traid of pain ,swelling ,tenderness .
*Depends upon the site of the of clot.
1-Pain :there is usually aching discomfort and tightness in the involved calf or thigh ,which are aggravated by muscular exercise .
2-Swelling :(it is the most reliable physical sign )
-In calf thrombosis .......swelling is limited to foot and ankle.
-In femoral thrombosis .....swelling involves calf and lower part of thigh.
-In iliofemoral thrombosis .....swelling affects whole leg.
3-Tenderness :present on grasping the affected leg.
NB: Although I hope from you to stay long time on my blog ,but you shoud know that blood clots in legs occurring in sitting on computer for prolonged time.
Homan sign :
*Pain is felt in calf on dorsiflexion of foot ,it is not reliable sign as it may be falsely positive in cases of muscle contusion or celllulitis.
a-General : Pulmonary embolism
b-Local ;
1-Early ;
*Phlegmaasia alba dolens :massive blood clots in legs may be associated with severe arterial spasm and lymphangitis ,so the leg become pale , white and massively swollen with absent peripheral pulsation .
*Phlegmasia cerulae dolens : massive blood clots in legs may be associated with severe congestion and cyanosis and whole leg looks massively swollen and blue and if not probably treated , it may lead to venous gangrene.
2-Late :
*Post phlebitic leg
*Venous gangrene
NB :The most dangerous blood clots in legs which need the longest period of treatment is ileofemoral venous blood clots.
0 Comments