Interviewer: It's time for "ER or Not" on The Scope. That is where we give you a scenario and then you tell us whether or not you think you should go to the ER. So feel free to play along at home. Dr. Troy Madsen is an emergency room physician at University of Utah Hospital. Dr. Madsen, here's a scenario. You've been on a long car trip, maybe 8 to 10 hours driving from somewhere, and then you notice that your leg is swollen. ER or not?
Deep Vein Thrombosis
Dr. Madsen: This is definitely a reason to go to the ER. In this scenario you've described, this is something we think of a deep vein thrombosis or a DVT. It basically means a clot in the deep veins, the really big veins in your leg. If you've been on a long trip, long plane flight, maybe you've had surgery recently, there are lots of different things that can put you at higher risk for this.
But the bottom line is if you've got swelling in your leg, you've got pain in your calf, the first thing that goes through my mind is do you have a clot in your leg. So I'd recommend going to the ER. If you go to an urgent care, I can tell you they will send you to the ER because typically they're not going to have an ultrasound there to do a test to look for this, and that's really the test you need. We can do an ultrasound in the ER We have our vascular technicians who are trained specifically to look for these clots. They'll look all up and down the veins, these deep veins in the leg, to see if there's any sign of a clot there.
The reason this is kind of a big deal is not just because of swelling in your leg and maybe it hurts a little bit, but if that clot continues to grow and gets bigger, it can then break loose and go to your lungs. Once it goes to your lungs, it's called a pulmonary embolism and that's a life-threatening condition. Once we diagnose a deep vein thrombosis, we get you on blood thinners. We make sure that clot's not getting bigger. That clot will gradually go away. Usually, you will be on blood thinners for about three months, just to make sure that's treated and make sure everything gets better. But absolutely, swelling in the leg after a long trip, go to the ER.
Interviewer: In both legs or just one leg?
Dr. Madsen: It's usually just one leg. It's really unusual to see clots form in both legs. The times I've seen those have been people who have had chronic health conditions, maybe a recent surgery, something that really puts them at higher risk for forming lots of clots. Ninety-nine percent of the time we see these, it's one leg. As you mentioned, often, it's after long travel or . . .
When Are You Likely to Get a DVT?
Interviewer: Sitting for a long time?
Dr. Madsen: Yeah, sitting for . . .
Interviewer: Even just at a desk job?
Dr. Madsen: That could put you at higher risk for it, but usually it's when people are doing something that's kind of out of the norm. So people who are sitting for a long time at a desk job, they've done it for years. They're kind of used to it. They know to get up and walk around. It's usually the people who have had, like, a 12-hour drive from somewhere and get out of the car, and then a day later, their calf starts to hurt. That's often when we see it.
updated: October 16, 2020
originally published: December 16, 2016