ZyraDoc #20 - August 21, 2026

A 48-year-old woman presents with a 3-day history of unilateral left lower extremity swelling, warmth, and calf tenderness following a 12-hour cross-country flight.

Physical examination reveals a 4 cm difference in calf circumference, mild erythema, and a high clinical probability (Wells score = 3) for deep vein thrombosis.

The junior resident recommends ordering a high-sensitivity D-dimer assay to rule out venous thromboembolism before deciding on ultrasound imaging.

Case Summary

Clinical Focus:

A 48-year-old female presents with acute unilateral lower extremity swelling and a high Wells score indicative of deep vein thrombosis (DVT).

Diagnostic Features of Acute DVT:

Unilateral leg pain, swelling, warmth, and asymmetry (at least 3 cm calf circumference difference)
High clinical probability (Wells score ≥ 2): Recent immobilization/travel, active localized vein tenderness, entire leg swelling

In high clinical probability cases, diagnostic compression ultrasonography is required directly, without ordering a D-dimer assay.

Here is the Management Strategy:

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