Are you fit for emergencies?

A 29-year-old woman presents at the emergency department with acute pain in her right leg. The area shows tenderness on palpation. There is no apparent swelling, but a slight redness of the skin.

What is your suspected diagnosis, and what diagnostic test is best able to confirm it?

a) The patient could have a fracture, so I would send her for an X-ray.

b) The patient might have erysipelas, and a blood sample should be taken before starting antibiotics.

c) The patient could have a deep vein thrombosis, and ultrasound with compression sonography is the preferred diagnostic test to find out.

d) The patient could develop a pulmonary embolism secondary to a DVT, so it's important to monitor for any chest pain or respiratory difficulties.

Do you know the answer?

Correct, you suspect a DVT! Compression sonography is the modality of choice to diagnose or rule out deep vein thrombosis, in combination with a D-dimer blood test. 

You perform compression sonography on both legs: Here’s what your ultrasound image looks like when scanning the top third of the right leg.

What do you see?

Which of the following in the context of deep vein thrombosis is correct?

Multiple answers are possible:

a) A DVT is confirmed.

b) There is a DVT but the clot is not visible, which makes the diagnosis more difficult

c) High pressure is required when performing compression sonography on the patient's leg to compress both the veins and arteries.

d) The size of the DVT is not yet determined. Complete compression sonography of both legs to determine its extent is required.

Do you know the answer(s)?

The correct answers are: 

a) A DVT is confirmed.

d) The size of the DVT is not yet determined. Complete compression sonography of both legs to determine its extent is required.

Are you interested in learning how to solve cases like these? Then check out the Emergency & Critical Care Ultrasound Essentials! Through several cases like this, the course will teach you how to perform point-of-care ultrasound in the emergency department and ICU, as well as how to master critical situations. Register now for our free lectures to get a first glimpse into the course!

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