Deep vein thrombosis occurring in the lower limbs is often difficult to diagnose from the history and physical examination. Some individuals present with pain and swelling of the calf muscle, others are asymptomatic. The obstruction to the vein causes chronic congestion of the muscle tissues which become edematous. The diagnosis may be confused with other conditions that cause aches and pains in the lower limbs such as a muscle tear, muscle cramps, a ruptured Baker’s cyst, cellulitis, and postphle-bitic syndrome. The presence of associated precipitating factors for deep venous thrombosis listed above lends strong support to its diagnosis.
B. Diagnostic Testing
1. D-Dimer
The measurement of the degradation products of cross¬link fibrin (D-dimer) circulating in the bloodstream is a highly sensitive but nonspecific screening test for sus¬pected venous thromboembolism. D-dimer is measured by enzyme-linked immunosorbent assay (ELISA). A negative test result, however, provides reassurance in more than 90% of cases that a serious event such as pulmonary embolism is not present. Clinical studies indicate that deep venous thrombosis can be ruled out in a patient who is judged clinically unlikely to have deep vein thrombosis and who has a negative D-dimer test.

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