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C. Seth Landefeld, MD

JAMA. 2008;300(14):1696-1697.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

More than a million patients in the United States seek medical care each year for leg pain and swelling.^1-2 Often, these symptoms raise the specter of deep vein thrombosis (DVT), which is diagnosed in roughly 20% of those persons evaluated.³ Proximal DVT—thrombosis of an iliac, deep femoral, or popliteal vein—is rightly feared. Untreated, proximal DVT often leads to symptomatic pulmonary embolism, which may be fatal, to progression or recurrence of the DVT, and to the postthrombotic syndrome of chronic pain, swelling, and difficulty walking. Anticoagulant therapy for proximal DVT prevents these complications in most patients⁴; however, this treatment is inconvenient, costly, and sometimes harmful, and must be avoided in patients whose symptoms are not attributable to DVT. The accurate diagnosis of proximal DVT is therefore critical.

Diagnosing DVT by physical examination is inaccurate, and until 25 years ago, radiocontrast venography was the only accurate diagnostic . . . [Full Text of this Article]

Author Affiliations: University of California, San Francisco, San Francisco Veterans Affairs Medical Center, and the Center for Advanced Study in the Behavioral Sciences at Stanford University, Stanford, California.

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