## Distinguishing Acute DVT from Chronic Varicose Veins ### Clinical Presentation Timeline **Key Point:** Acute DVT presents with sudden-onset unilateral calf swelling, pain, warmth, and pitting edema over hours to days, whereas chronic varicose veins develop insidiously over years with progressive symptoms. ### Comparison Table | Feature | Acute DVT | Chronic Varicose Veins | | --- | --- | --- | | **Onset** | Acute (hours–days) | Insidious (months–years) | | **Swelling** | Unilateral, pitting, acute | Bilateral possible, non-pitting initially | | **Pain character** | Sharp, tender calf | Dull ache, heaviness | | **Warmth** | Present (acute inflammation) | Absent | | **Visible veins** | May not be prominent | Dilated, tortuous, obvious | | **Skin changes** | Erythema, possible cellulitis | Hyperpigmentation, lipodermatosclerosis (chronic) | ### Why Acute Calf Swelling with Tenderness Discriminates **High-Yield:** The hallmark of acute DVT is **sudden unilateral calf swelling with pitting edema and calf tenderness** — a sign of acute venous obstruction and inflammatory response. This is absent in uncomplicated chronic varicose veins, which present with gradual onset, heaviness, and visible dilated veins without acute swelling. **Clinical Pearl:** Homan's sign (calf pain on dorsiflexion) and Pratt's sign (medial thigh pain on compression) are classically taught but have low sensitivity and specificity; acute swelling + tenderness + Doppler findings are diagnostic. ### Pathophysiology Acute DVT causes: 1. Sudden venous obstruction → proximal venous hypertension 2. Increased capillary hydrostatic pressure → pitting edema 3. Acute inflammatory response → warmth, erythema, tenderness Chronic varicose veins cause: 1. Gradual valve incompetence → reflux 2. Progressive venous dilation → visible tortuous veins 3. Chronic venous hypertension → skin pigmentation and fibrosis (late) [cite:Sabiston Textbook of Surgery 21e Ch 64]
Sign up free to access AI-powered MCQ practice with detailed explanations and adaptive learning.