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How many cms bigger would one calf have to be over the other…

How many cms bigger...

How many cms bigger would one calf have to be over the other before DVT is suspected, mine is 1.5cm, feels like a sprained muscle but I haven't sprained it and have recently undertaken a 10 hour car journet

Doctor's Assistant: What are all the symptoms you're experiencing (e.g. loss of appetite, fever, rash)?

Hello - no other symptoms and not on any medication

Doctor's Assistant: What medications do you take daily? Are you allergic to any medications?

No medication - just a long car journey and a painful calf AND thigh muscle

Doctor's Assistant: Anything else in your medical history you think the doctor should know?

I had a small blood clot in my arm 3 years ago after a longhaul flight

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Answered in 6 minutes by:
3/15/2018
Doctor Jennifer
Category: Medical
Satisfied Customers: 134
Experience: Surgery Fellow
Verified

Hi, I'm Dr Jennifer and I'm a surgery fellow.

As you seem to already know, long immobilization and a history of a DVT put you at high risk for another DVT. With a swollen painful leg, I'd be suspicious for DVT and would want an ultrasound if I were seeing you in the emergency room or the office. Difference in calf diameter is one of the few other good positive predictive findings, but I don't know what cutoff has been used in the studies that show that.

Give me a minute and I'll see if I can find a reference that is specific for a cutoff.

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By the Wells criteria, the difference ought to be >3 cm. However, with tenderness along the deep venous system, or one of the other criteria (https://www.mdcalc.com/wells-criteria-dvt), with your history you would score high risk.

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Customer reply replied 5 months ago
thanks - it is less than 2cm and there is a 3 weeks waiting list here for ultrasound scans
Customer reply replied 5 months ago
finally would the symptoms be likely to replicate a pulled muscle with difficulty in walking - or is it actually more likely to be simply a pulled muscle - possibly done at night so I was not aware of it?

Oh jeez! I'm US trained and now work in France, but if you have a DVT, you should be put on a blood thinner much sooner than that. Is it possible if you went to an urgent care or your own doctor, and they agree that it's likely you have a DVT, that it would be done sooner? It wouldn't be an elective ultrasound then?

It's possible, but if there's noticeable swelling, it's less likely to be a pulled muscle.

Does the muscle hurt all the time or only when you flex and extend your foot?

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After your other DVT, were you screened for clotting disorders, or put on aspirin?

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Customer reply replied 5 months ago
it only hurts when walking, not at rest

If you flex your toes up toward your knee while you're sitting or lying down, does it hurt your calf muscle?

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Customer reply replied 5 months ago
last time I was treated in Dubai so they did the ultrasaound within one hour, privately - I took blood thinners for 3 months
Customer reply replied 5 months ago
no - flexing toes upwards does not hurt

Ok, that's a classic exam maneuver for DVT, but unfortunately it isn't very sensitive, meaning it misses some DVTs.

If it is possible for you, I would ask a doctor if it would be possible to get an ultrasound sooner, since that's going to be the only way to find out if it's a DVT or not. Often times an acute diagnostic need goes into a separate list than a more routine diagnostic need. But I expect you know the NHS better than I do.

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Customer reply replied 5 months ago
ok thanks - I will try - but this is the north of Scotland and medical resources are almost non-existent

Another possibility would be to get a D-dimer blood test. If it is negative, you don't have a DVT; but if it is positive, it could be a DVT or something else. It could rule it out. Would that be any easier for you to get?

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There are a few things that can confuse that blood test, which are: severe liver disease, pregnancy, renal failure, being on blood thinners, atrial fibrillation, and infections. If none of those apply to you, it should be reliable.

Doctor Jennifer
Category: Medical
Satisfied Customers: 134
Experience: Surgery Fellow
Verified
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