Clinical Practice and Cases in Emergency Medicine

Isolated pelvic DVTs are rare and difficult to diagnose, but are more common in pregnant women and carry an increased risk of embolization.  Pulmonary embolism (PE) is the most common non-obstretric cause of death in pregnancy.  Compression ultrasound is the first-line imaging test for suspected lower extremity DVT, but it cannot usually directly visualize or easily diagnose isolated pelvic DVT.  Nonetheless, Point of Care Ultrasound (POCUS) may provide valuable clues to help rule in pelvic DVT and expedite initiation of anticoagulant therapy.  Such findings include increased venous diameter, increased resistance to compression, visible venous reflux, and blunted phasicity.  This case presents an example of how these findings on POCUS led the emergency physician to make the difficult diagnosis of pelvic DVT at the bedside within seconds.