Our patient has a possible DVT. She has a painful, swollen left leg with some mild erythema. The Wells’ score is 1 and therefore a d-dimer test is required. Had the score been 2 it would be reasonable to move to an ultrasound doppler scan of the lower limb. If the patient was pregnant the Wells’ score and d-dimer wouldn’t apply as it is not validated in pregnancy and often the d-dimer is elevated in the pregnant state. Ther astute GP has done a pregnancy test and it is negative.
She is referred to an ambulatory care centre where a d-dimer is requested and it is positive; therefore she needs an ultrasound scan of the lower limb.
- What are the other causes of raised d-dimer?
- Would you do an ultrasound of the whole leg or limited to the thigh?
- If an ultrasound scan is not available today what would you do?
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