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On Difficulties in Diagnosing Deep Vein Thrombosis in Daily Clinical Work and Research Practice by Bjoergell O, Nilsson PE, Nilsson J-Å, Svensson PJ

This article enlightens the diagnostic difficulties when performing and interpreting a phlebography or color Doppler ultrasonography (CDU), which may have serious consequences in the daily clinical and laboratory work. In laboratory research as well as in clinical trials the most fundamental principle is to obtain a correct diagnosis. Less than 50% of patients with deep venous thrombosis (DVT) manifest the classical symptoms and signs of DVT and consequently the diagnosis is based upon methods such as phlebography or CDU. Some veins are especially hard to display, i.e. the veins of the planta pedis, the deep muscle veins of the calf and thigh and the deep internal iliac vein. Thus, the ideal diagnostic method must display the whole venous system from the planta pedis to the caval vein. A false negative examination puts the patient at risk of pulmonary embolism, which may present with a sudden onset and fatal outcome. A. venous dysfunction as well as recurrent DVT will also be a continuous risk factor. A false positive interpretation may result in unnecessary anticoagulation treatment and bleeding complications. The combination of phlebography and CDU together with the strict use of a scoring method will increase the possibility of a proper diagnosis focusing on the diagnostically difficult areas of the venous system.

DOI: Clin. Lab. 2001;47:369-375