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Internal Medicine

Answer 2
  1. Order compression ultrasonography. Compression ultrasonography is noninvasive and has a sensitivity of 70% and a positive predictive value of 80% for isolated calf vein thrombosis. To evaluate a possible extension of the calf vein thrombosis into the proximal veins, a follow-up ultrasonography 1 week after initial ultrasonography is recommended. The sensitivity and specificity of compression ultrasonography for proximal DVT is more than 95%.1 Venography can be used when ultrasonography is negative in a patient with highly suggestive clinical signs and symptoms (eg, pain in the leg, leg tenderness, swelling). The probability that the patient has decompensated heart failure is low (unilateral leg swelling and no shortness of breath), and therefore measurement of brain natriuretic peptide is not warranted.

     Kearon C, Julian JA, Newman TE, Ginsberg JS. Noninvasive diagnosis of deep venous thrombosis. McMaster Diagnostic Imaging Practice Guidelines Initiative [published erratum appears in Ann Intern Med 1998; 129:425]. Ann Intern Med 1998;128:663-77.

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