PS1.244Deep vein thrombosis detected in primary care

C Tusa(1), Violeta Rodriguez(1), JA Cuenca(2), A Tomas(1), N Rivera(1), A Santamaria(3), G Amodeo(4), P Berenguel(5)
(1) Resident of 3rd year in Family Medicine, Hospital de Poniente, El Ejido, Spain
(2) Resident of 5th year, Internal Medicine, Hospital de Poniente, El Ejido, Spain
(3) Resident of 4th year in Family Medicine, Hospital de Poniente, El Ejido, Spain
(4) Resident of 2nd year in Family Medicine, Distretto Sanitario 6, Palermo, Italy
(5) Family doctor, Emergency department, Hospital de Poniente, El Ejido, Spain
Corresponding author: Mrs Violeta Rodriguez, Hospital Poniente, Emergency, El Ejido, Almeria, Spain.
Context: 46 year old woman with no relevant medical history or active medication except oral contraceptives, which came to our primary care clinic with symptoms of a few hours of itching, pain and oedema in left lower limb.
Methods:  Examining the patient: good overall condition, mild pale skin and mucous membranes, haemodynamically stable.
Lower limbs swollen of the entire left lower extremity, hard, pasted, positive Homan's sign. Wells Score: 4.
Having a high suspicion of DVT, we derive the patient to the emergency room for evaluation and complementary studies as may be lower limb Doppler ultrasound and laboratory tests.
Results: In the emergency room the following examinations and additional tests were performed.
analytical Values ​​of note:
D-dimer: negative (Ekg: Sinus rhythm at 80 beats per minute, with no signs of ischaemia or hypertrophy.
Conventional X-ray chest film: unchanged.
Even with negative D Dimer, guided by a very suggestive physical examination (Wells Criteria> 3), it was decided to ask Eco colour Doppler lower limb, which resulted in a deep vein thrombosis in the left popliteal vein.
As oral contraceptive treatment was suspended and added 120 mg subcutaneous enoxaparin daily to meet in haematology.
Conclusions: It is important to consider that negative D dimer not always excludes deep venous thrombosis because what is really vital to any doctor, either in primary care or not, is the clinic patient.