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It has been suggested that Doppler ultrasound examination is useful in the diagnosis of deep venous thrombosis (DVT). The present study was undertaken to compare ultra sound with venography in 120 limbs of 106 patients who presented with clinical DVT or pulmonary embolism. A Parks 801 ultrasonic detector was used over the femoral and popliteal veins with calf compression before and after occlusion of the long saphenous vein at the knee.DVT was confirmed by venography in 44 limbs and was confined to the calf in 10 of these. Ultrasound detected 3 calf thromboses and 29 of 34 more extensive thromboses. The five failures with thrombus proximal to the calf were associated with partial occlusion (1) or extensive collateral circulation (4). Of the 76 limbs normal on venography 21 were thought to have DVT by ultrasound: these false positives could be attributed to oedema (11), haematoma (4), lymphocyst (1), injured muscle (1), cellulitis (1) or excessive tenderness (2) and were unexplained in 1. The results indicate that this test is more accurate than clinical signs alone, but users must be aware of its limitations, particularly the causes of false positive and false negative results.