alt=Image of a leg with "pitting" edema, a transient depression of the skin after pressure is applied. When this happens on one side, it increases the likelihood of DVT. Symptoms classically affect a leg and typically develop over hours or days, though they can develop suddenly or over a matter of weeks. The legs are primarily affected, with 4–10% of DVT occurring in the arms. Despite the signs and symptoms being highly variable, the typical symptoms are pain, swelling, and redness. However, these symptoms might not manifest in the lower limbs of those unable to walk. In those who are able to walk, DVT can reduce one's ability to do so. The pain can be described as throbbing and can worsen with weight-bearing, prompting one to bear more weight with the unaffected leg. Additional signs and symptoms include tenderness, pitting edema (see image), dilation of surface veins, warmth, discoloration, a "pulling sensation", and even cyanosis (a blue or purplish discoloration) with fever. DVT can also exist without causing any symptoms. Signs and symptoms help in determining the likelihood of DVT, but they are not used alone for diagnosis. At times, DVT can cause symptoms in both arms or both legs, as with bilateral DVT. Rarely, a clot in the inferior vena cava can cause both legs to swell. Superficial vein thrombosis, also known as superficial thrombophlebitis, is the formation of a blood clot (thrombus) in a vein close to the skin. It can co-occur with DVT and can be felt as a "palpable cord". Migratory thrombophlebitis (Trousseau's syndrome) is a noted finding in those with pancreatic cancer and is associated with DVT. Acute complications A pulmonary embolism (PE) occurs when a blood clot from a deep vein (a DVT) detaches from a vein (embolizes), travels through the right side of the heart, and becomes lodged as an embolus in a pulmonary artery that supplies deoxygenated blood to the lungs for oxygenation. Up to one-fourth of PE cases are thought to result in sudden death. When not fatal, PE can cause symptoms such as sudden onset shortness of breath or chest pain, coughing up blood (hemoptysis), and fainting (syncope). The chest pain can be pleuritic (worsened by deep breaths) and can vary based upon where the embolus is lodged in the lungs. An estimated 30–50% of those with PE have detectable DVT by compression ultrasound. A rare and massive DVT that causes significant obstruction and discoloration (including cyanosis) is phlegmasia cerulea dolens. It is life-threatening, limb-threatening, and carries a risk of venous gangrene. Phlegmasia cerulea dolens can occur in the arm but more commonly affects the leg. If found in the setting of acute compartment syndrome, an urgent fasciotomy is warranted to protect the limb. Superior vena cava syndrome is a rare complication of arm DVT. DVT is thought to be able to cause a stroke in the presence of a heart defect. This is called a paradoxical embolism because the clot abnormally travels from the pulmonary circuit to the systemic circuit while inside the heart. The defect of a patent foramen ovale is thought to allow clots to travel through the interatrial septum from the right atrium into the left atrium. File:SaddlePE.alt=A computed tomography image depicting PE in the pulmonary arteries File:PCD2016.alt=Image showing marked discoloration of a leg with phlegmasia cerulea dolens Patent-foramen-ovale-en.alt=A drawing depicting a patent foramen ovale Differential diagnosis In most suspected cases, DVT is ruled out after evaluation. Cellulitis is a frequent mimic of DVT, with its triad of pain, swelling, and redness. Symptoms concerning for DVT are more often due to other causes, including cellulitis, ruptured<unk> 's<unk> , hematoma, lymphedema, and chronic venous insufficiency. Other differential diagnoses include tumors, venous or arterial aneurysms, connective tissue disorders, superficial vein thrombosis, muscle vein thrombosis, and varicose veins.
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