The patient attends EAU and more history is gained by the medical SHO.
She is a 31 year old female who has felt her right calf has been more swollen for the last three days. She has not had any symptoms of pulmonary embolism. She has not had recent surgery or immobilisation apart from a flight within Europe six months ago. She is not taking the oral contraceptive pill. She is an architect and is normally fit and well with no other major medical problems except for outlined in the GP letter below. She has not had a DVT previously and there is no family history of venous thromboembolism.
On examination the entire leg is swollen and the calf is slightly red and tender. There is no tenderness over the deep venous system. It does not look like cellulitis and she is not pyrexial. The calf is approx 3cm larger and there is mild pitting oedema in the affected leg. There are no obvious varicosities. No signs of pulmonary embolism.
Bloods including FBC, clotting screen, renal and liver function are requested. An ultrasound can be done today.
- Can you calculate the Well’s score? (http://www.nice.org.uk/nicemedia/live/13767/59714/59714.pdf)
- What else may you want to think about in terms of history and examination?
- Is an inherited thrombophilia screen useful at this point?
- Do you need a d-dimer?
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