DVT is unlikely if the clinical prediction score is low and the D-dimer levels are normal [3,6,10-12]. However, the highly variable nature of DVT presentation, numerous potential pathologic mimics for DVT, and variations in D-dimer assay performances in certain populations limit the reliability of diagnosis solely on the clinical DVT prediction score and D-dimer testing. DVT screening of select high-risk patients in intensive care units because of prolonged immobility has also shown benefit [13,14]. Lower extremity ultrasound (US) has also been included in an algorithm for the workup of patients who have a fever of unknown origin after more common causes have been excluded [15,16]. Imaging is frequently required to definitively exclude DVT and properly document the extent of venous thrombosis, which is critical for proper therapeutic management of DVT. Moreover, the clinical-prediction score The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through society representation on expert panels. Participation by representatives from collaborating societies on the expert panel does not necessarily imply individual or society endorsement of the final document. Reprint requests to: publications@acr.org Suspected Lower Extremity DVT and D-dimer level are often unreliable for diagnosing recurrent DVT and are not useful for diagnosing alternative conditions, such as an intact or ruptured Baker cyst, cellulitis, lymphedema, chronic venous disease, and various musculoskeletal disorders that can clinically mimic DVT. Discussion of Procedures by Variant Variant 1: Suspected lower extremity deep vein thrombosis. Initial imaging. Catheter Venography Pelvis and Lower Extremity Contrast catheter venography is the historic and de facto gold standard for diagnosing DVT [3,6,10,11].
Suspected Lower Extremity Deep Vein Thrombosis. DVT is unlikely if the clinical prediction score is low and the D-dimer levels are normal [3,6,10-12]. However, the highly variable nature of DVT presentation, numerous potential pathologic mimics for DVT, and variations in D-dimer assay performances in certain populations limit the reliability of diagnosis solely on the clinical DVT prediction score and D-dimer testing. DVT screening of select high-risk patients in intensive care units because of prolonged immobility has also shown benefit [13,14]. Lower extremity ultrasound (US) has also been included in an algorithm for the workup of patients who have a fever of unknown origin after more common causes have been excluded [15,16]. Imaging is frequently required to definitively exclude DVT and properly document the extent of venous thrombosis, which is critical for proper therapeutic management of DVT. Moreover, the clinical-prediction score The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through society representation on expert panels. Participation by representatives from collaborating societies on the expert panel does not necessarily imply individual or society endorsement of the final document. Reprint requests to: publications@acr.org Suspected Lower Extremity DVT and D-dimer level are often unreliable for diagnosing recurrent DVT and are not useful for diagnosing alternative conditions, such as an intact or ruptured Baker cyst, cellulitis, lymphedema, chronic venous disease, and various musculoskeletal disorders that can clinically mimic DVT. Discussion of Procedures by Variant Variant 1: Suspected lower extremity deep vein thrombosis. Initial imaging. Catheter Venography Pelvis and Lower Extremity Contrast catheter venography is the historic and de facto gold standard for diagnosing DVT [3,6,10,11].