Deep blood clots in legs (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.

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 *Venous gangrene

NB :The most dangerous blood clots in legs which need the longest period of treatment is ileofemoral venous blood clots.