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Venоus dоppler ultrаsоund performed by а quаlified sonographer has a sensitivity and specificity of approximately 95% in the detection of deep vein thrombosis (DVT) of the proximal leg. The evaluation typically includes three different points: common femoral vein, superficial femoral vein, and the popliteal vein. In patients with a high pre-test probability (as in this case of a woman with a high-risk Wells score), a repeat duplex ultrasound is indicated inpatients with persistent symptoms. An alternative approach on the initial visit is to also perform a D-dimer which, if negative in combination with the three-point ultrasound, excludes the diagnosis of DVT. A D-dimer (B) would perhaps be appropriate for a low risk patient, however, given this patient's repeat presentation in the setting of oral contraceptives with a consistent physical exam for DVT it would be more appropriate to perform a repeat ultrasound.