Deep venous trombosis diagnostic algorithm

Aim: We aimed to find out the role of serum homocysteine level in DVT in adult patients treated with a preliminary diagnosis of deep vein thrombosis (DVT), with the effect of three-point USG and thermal camera in the emergency department on the diagnostic priority and algorithm. Materials and Methods: In our study, 65 patients who were evaluated in the emergency department with the diagnosis of DVT were evaluated prospectively. Patients with DVT included in the study were classified as developing Pulmonary Embolism (PE) (Group 1) and not developing PE (Group II). Demographic and clinical presentation of the patients, Wells scores, imaging characteristics, thermal imaging and three-point USG results, blood tests and complications were evaluated. Results: The mean age of the patients in our study was 58.2±17.5 years, and 66.2% of the patients were male. While the frequency of dyspnea was high in cases with PE, the frequency of leg pain was found to be significantly higher in cases without PE (p<0.05). The number of smokers in the group with PE was found to be high (p<0.05). In our study, thrombus was detected most frequently in the popliteal vein (55.4%) and femoral vein (46.2%) in the USG of the patients, and the frequency of PE was significantly lower in patients with thrombus in the saphenous vein (p<0.05). In our study, homocysteine levels were high in 81.5% of the patients, and we evaluated no differences in the levels of patients with and without PE (p>0.05). In our study, we detected positive imaging in 62 (95.4%) patients in the thermal camera. Although the diagnostic rate of thermal imaging camera was higher in the group with DVT+PE, we evaluated this difference as statistically nonsignificant (p>0.05). We evaluated that the RBC count was significantly lower and the RDW level was significantly higher in cases with PE (p<0.05). Conclusion: three-point USG, thermal imaging camera and homocysteine level were effective in the diagnosis of DVT. Also CRP, vitamin D, and lactate levels are other helpful methods in diagnosis. Additional studies are needed to demonstrate the specificities of these methods. Keywords: Deep vein thrombosis, homocysteine, pulmonary embolism, thermal camera, ultrasonography