Diagnostic performance of complete lower limb venous ultrasound in patients with clinically suspected acute pulmonary embolism

Abstract

A limited ultrasound (US) confined to the popliteal and femoral veins is usually performed to detect deep vein thrombosis (DVT) in patients with clinically suspected acute pulmonary embolism (PE). Our objective was to assess the diagnostic accuracy of complete lower limb US examining both the proximal and distal veins in this setting. In this prospective study, 210 consecutive patients were included. Complete US was performed by independent operators and compared blindly with a reference strategy combining clinical probability, ventilation perfusion scan and pulmonary angiography to a three-month clinical follow-up. Simultaneously, VIDAS D-dimer (DD) assay and helical computed tomography (HCT) of the lungs were assessed independently and blindly. PE was present in 74 patients (35%). Complete US detected DVT in 91 patients (43%), proximal in 51 and distal in 40. Sensitivity and specificity with a 0.95 confidence interval were respectively 0.93 [0.85 - 0.97] and 0.84 [0.77 - 0.89]. Limited US detected DVT in only 46 patients (22%). Sensitivity and specificity were respectively 0.55 [0.44 - 0.66] and 0.96 [0.92 - 0.98]. For DD they were 0.92 [0.83 - 0.96] and 0.24 [0.17 - 0.32] and for HCT 0.84 [0.73 - 0.90] and 0.87 [0.80 - 0.92]. Complete lower limb US has higher sensitivity and capacity to exclude PE than limited US, but a slightly lower specificity. Complete US results also compared favourably with those of HCT and DD. The utility of including this method in diagnostic strategies for PE needs to be assessed in cost-effectiveness analysis and in outcome studies.

Clinical Significance of the Soleal Vein and Related Drainage Veins, in Calf Vein Thrombosis in Autopsy Cases with Massive Pulmonary Thromboembolism

“…The reported incidence of isolated calf DVT in PE patients is relatively low; it is 14% by ultrasound, 18) 20% by venography 19) and 13%-15% by autopsy. 5,6) …”

“…9, No. 1; 2016; pp [15][16][17][18][19][20][21] Online December 11, 2015 ©2016 Annals of Vascular Diseases doi:10.3400/avd.oa. who had pre-fatal examinations or any treatment for VTE were excluded from this study.…”

A Retrospective Evaluation of Patients Admitted to Emergency Departments with Pulmonary Thromboembolism

“…In our study, the age group of patients (aged ≥65) with PTE constitutes nearly half of the cases. The great majority of pulmonary thromboembolism cases (75%) are due to the thrombus in deep leg veins (1,12). Risk factors for PTE include both acquired and hereditary factors.…”

Pulmonary embolism: clinical guidelines of European Society of Cardiology (2014).The Task Force of the European Society of Cardiology for diagnosis and management of pulmonary embolism

“…Диагностическую ценность КУЗИ при подозрении на ТЭЛА можно повысить, выпол нив полное УЗИ, включая дистальные вены. В 2 не давних исследованиях оценивалась доля больных с подозрением на ТЭЛА и повышением D димера, у которых ТГВ диагностировалось с помощью пол ного КУЗИ [195,196]. Диагностическая ценность полного КУЗИ почти вдвое превосходила ценность проксимального КУЗИ, но при этом у 26-36 % боль ных с дистальным ТГВ ТЭЛА при МДКТ грудной клетки отсутствовала.…”

“…Таким образом, выполнение КУЗИ перед КТ может быть Таблица 6 Валидизированные критерии диагноза для диагностики ТЭЛА у больных без шока и гипотензии (на основании неинвазивных методов исследования) в соответствии с клинической вероятностью Примечание: * -результат сцинтиграфии с низкой или средней вероятностью ТЭЛА по классификации PIOPED; «+» -надежные диагностические критерии, не требующие дальней шего обследования; «-» -ненадежные критерии, рекомендуется дальнейшее обследование; «±» -противоречивые критерии (желательно дальнейшее обследование). тактикой выбора у больных с относительными про тивопоказаниями к проведению КТ, такими как по чечная недостаточность, аллергия на рентгеноконт растные вещества, беременность [195,196]. Значение V/Q сцинтиграфии легких.…”