question-icon

Suggest Treatment For Popliteal DVT

default
Posted on Sat, 28 Feb 2015
Question: I would like to speak to a vascular specialist. I have a large popliteal DVT from using a knee walker after breaking my foot. I have had to doppler/US, one in the ER and another through a private vascular specialist which I do not wish to go back. I was started on Xarelto 15mg in the ER and have taken it twice a day for 3 weeks and now I'm on 20mg once a day. My back of my knee, which no one has looked at, has not gone down any. I've had no swelling, just a protrusion in the popliteal area. Now I'm feeling a medium size bump on the lateral back of the knee. It may be in a vein. I also have a bone on the side of the knee which is jutting out more than the other. My question is, do you think I possibly have another DVT? Also, it is slightly painful when I'm hopping on my crutches. Everyone tells me I'm safe because I'm on anticogulants. Something I forgot to tell you is that my leg is cool to the touch and I've told all the doctors I've seen. No one seems to think too much of it. My color of my leg is normal, feeling is normal, have a pedal pulse. When I awake in the morning, it's nice and warm. The DVT was large and almost occluded my whole vein. I'm trying to find a new vascular specialist in NYC, but have not had any luck so far. do you think I should go for my 3rd doppler/US or should I wait for the 3 months. Sorry, a lot of questions.
doctor
Answered by Dr. S. Samanta (1 hour later)
Brief Answer:
SERIAL DOPPLER NEEDED AS THIS IS RECURRENT!

Detailed Answer:
Respected Madam,

After going through your history of trauma, medication, investigations and queries in different issues, I would like to mention that:

1. DVT is generally recurrent as there are usually some predisposing condition in any patients for example, prolonged bed rest, medications, varicose veins, trauma, Hormonal pills, polyvythemia, multiple myeloma, anti-thrombin factors deficiencies, etc. etc...

2. One needs to identify the condition with him/her that is responsible in every case and should avoid it!

3. cold limb indicates poor blood circulation therefore passive physiotherapy is helpful.

4. serial doppler not only updates the old one but also detects new DVTs if any

5. your medication is okay and sufficient to prevent further DVTs provided you take care about any predisposing factor with you!

Kindly revert back to me if any more queries.

Wishing you complete recovery!
Above answer was peer-reviewed by : Dr. Shanthi.E
doctor
default
Follow up: Dr. S. Samanta (53 minutes later)
I have no risk factors other than immobility from fractured foot. my veins and arteries are perfect and circulation on Doppler was normal. I asked about the new bump I saw and why my leg was cold at times. it was cold with the two dopper ultrasounds I had but again circulation was perfect except in the popliteal vein.
doctor
Answered by Dr. S. Samanta (1 hour later)
Brief Answer:
IT IS NOT DVT BUT A BENIGN CYSTIC LESION!

Detailed Answer:
Respected Madam,

Assuming the report is rechecked by a second radiologist, I must suggest that this new bump could be a popliteal herniation of some dilated vein, a bursa or a degenerative cyst.

Your cold limb skin is due to trophic changes related to nerves or could be partial occlusion of arteries rather than vein; therefore, investigations to rule out atherosclerosis or arteriosclerosis could be suggested!

If still everything is normal then a fine needle aspiration biopsy could be helpful to confirm the diagnosis.

regards,
Above answer was peer-reviewed by : Dr. Ashwin Bhandari
doctor
default
Follow up: Dr. S. Samanta (5 hours later)
please read the questions before answering. recurrent Dvt now artherosclerisis now cyst. all veins and arteries on both scans normalp and clear for the third tlime. all labsblsnormal.
doctor
Answered by Dr. S. Samanta (2 hours later)
Brief Answer:
THESE ARE SEPARATE AND POSSIBILITIES ONLY!

Detailed Answer:
Dear Madam,

You concluded, 'Something I forgot to tell you is that my leg is cool to the touch and I've told all the doctors I've seen. No one seems to think too much of it. My color of my leg is normal, feeling is normal, have a pedal pulse. When I awake in the morning, it's nice and warm. ...' But please please get it checked by a doctor otherwise you cannot be sure about this!

And, absolutely a cyst/ bursa due to to degenerative changes in the knee joint is a possibility - this is my opinion only which needs confirmation by a direct examination; sorry we cannot examine but can visualize only!

And cold limbs are associated with trophic factors / arterial factors like atherosclerosis which is the most common reason!

regards,
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
doctor
Answered by
Dr.
Dr. S. Samanta

Pathologist and Microbiologist

Practicing since :2004

Answered : 1107 Questions

premium_optimized

The User accepted the expert's answer

Share on

Get personalised answers from verified doctor in minutes across 80+ specialties

152 Doctors Online

By proceeding, I accept the Terms and Conditions

HCM Blog Instant Access to Doctors
HCM Blog Questions Answered
HCM Blog Satisfaction
Suggest Treatment For Popliteal DVT

Brief Answer: SERIAL DOPPLER NEEDED AS THIS IS RECURRENT! Detailed Answer: Respected Madam, After going through your history of trauma, medication, investigations and queries in different issues, I would like to mention that: 1. DVT is generally recurrent as there are usually some predisposing condition in any patients for example, prolonged bed rest, medications, varicose veins, trauma, Hormonal pills, polyvythemia, multiple myeloma, anti-thrombin factors deficiencies, etc. etc... 2. One needs to identify the condition with him/her that is responsible in every case and should avoid it! 3. cold limb indicates poor blood circulation therefore passive physiotherapy is helpful. 4. serial doppler not only updates the old one but also detects new DVTs if any 5. your medication is okay and sufficient to prevent further DVTs provided you take care about any predisposing factor with you! Kindly revert back to me if any more queries. Wishing you complete recovery!