Blood Clots (cont.)
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Blood Clots Diagnosis
The initial step in making the diagnosis of a blood clot is obtaining a history. Since patients rarely are able to state that they have a blood clot, the healthcare professional will ask questions about what might be occurring. If a blood clot or thrombus is a consideration, the history may expand to access the patient's risk factors or situations that might have put the patient at risk for forming a clot.
Physical examination will help add information to increase the suspicion for a blood clot.
Testing for venous blood clots
Computerized tomography (CT) is often the test of choice when suspicion of pulmonary embolus is high. Contrast is injected intravenously, and the radiologist can determine whether a clot is present.
On occasion, ventilation perfusion (V/Q) scans are performed to look for pulmonary emboli. This test uses labeled chemicals to identify inhaled air into the lungs and match it with blood flow in the arteries. This test is less accurate than a CT scan and is subjective to variances in interpretation.
MRI may be considered as test to look for pulmonary embolus, especially in a pregnant patient, when radiation exposure from CT scanning is of concern.
Testing for arterial blood clots
Arterial thrombosis is an emergency, since tissue cannot survive very long without blood supply before there is irreversible damage. In an arm or leg, often a surgeon is immediately consulted. Arteriography may be considered. Arteriography is a technique in which dye is injected into the artery in question to look for blockage. Sometimes, if there is a large artery that is occluded, this test is done in the operating room with the presumption that a surgical procedure will be necessary to open the vessel and restore blood flow.
For an acute heart attack, the EKG may confirm the diagnosis, although blood tests may be used to look for enzymes (troponin) that leak into the bloodstream from irritated heart muscle. With an acute heart attack, the diagnostic and therapeutic procedure of choice is a heart catheterization.
For an acute stroke (cerebrovascular accident, CVA), the test of choice is a computerized tomography (CT) scan of the head to look for bleeding or tumor as the cause of stroke symptoms. If the stroke symptoms resolve, meaning that a transient ischemic attack (TIA) has occurred, tests may include carotid ultrasound to look for blockage in the major arteries of the neck and echocardiography to look for blood clots in the heart that may embolize to the brain.
Medically Reviewed by a Doctor on 8/27/2015
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