Diagnostic utility of color Doppler ultrasound in lower limb deep vein thrombosis in patients with clinical suspicion of pulmonary thromboembolism

Fernandez-Canton, G.; Vidaur, Ignacio Lopez; Muñoz, Fernando; Antoñana, M.A.; Uresandi, Fernando; Calonge, Jose

doi:10.1016/0720-048x(94)00569-x

Cited by 11 publications

(6 citation statements)

References 14 publications

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“…However, we believe that their detection may be useful in the management of PE for several reasons: -Patients with PE frequently have not only proximal but also distal DVT. Autopsy (7,9,10), venography (12,29) and magnetic resonance direct thrombus imaging studies (30) show that PE is associated in up to 93% of cases with lower limb and pelvic DVT and in up to 60% with isolated calf thrombi (29). PE and fatal PE may originate directly (31,32) from the calf veins which may be enlarged by the thrombus to as much as the diameter of the inferior vena cava (personal observations), but they may also originate from a more proximal thrombus which has migrated, leaving a residual thrombus in the calf as a marker of PE.…”

Section: Discussionmentioning

confidence: 99%

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

Elias¹,

Colombier²,

Victor³

et al. 2004

Thromb Haemost

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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.

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Section: Discussionmentioning

confidence: 99%

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

Elias¹,

Colombier²,

Victor³

et al. 2004

Thromb Haemost

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“…If all the tests are negative and PE still highly suspected, ultrasound of the lower limbs may be needed. 61,62 It has been demonstrated that in patients with high clinical suspicion for PE, negative CTPA and negative lower limb ultrasound, the chance of missing a PE could be as high as 7%. 63 Therefore, further testing may be required to evaluate these patients in order to confidently exclude PE or establish an alternative diagnosis.…”

Section: Laboratory Testsmentioning

confidence: 99%

Pulmonary Embolism in the Mechanically-Ventilated Critically Ill Patient: Is it Different?

Zochios

Keeshan

2013

Journal of the Intensive Care Society

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Acute PE results in increased right ventricular (RV) afterload. If the afterload is severely increased, RV enlargement, hypokinesis, ischaemia and RV failure may ensue. 13,14 The concomitant release of vasoactive and bronchoactive humoral factors such as serotonin from platelets, thrombin from plasma and histamine from tissue, have all been implicated in both pulmonary oedema and the ventilation-perfusion mismatch seen. 15 Experimental data suggest that the main mechanisms involved in hypoxaemia and the increase in the alveolararterial oxygen tension gradient are shunt, low ventilationperfusion ratio (V/Q), decrease in the mixed venous partial Pulmonary embolism in the mechanicallyventilated critically ill patient: is it different? 2C03, 3C00VA Zochios, A Keeshan Pulmonary embolism (PE) confers significant in-hospital morbidity and mortality, and critically ill patients remain at risk for venous thromboembolism despite thromboprophylaxis. Recognition of the clinical manifestations and immediate management of PE are of paramount importance. Despite diagnostic advances, PE is often undiagnosed and untreated in patients receiving mechanical ventilation, as these patients do not exhibit the common clinical features of the condition, making the diagnosis very challenging. Computed tomographic pulmonary angiography is probably the reference standard for the diagnosis of acute PE in the haemodynamically stable, ventilated patient. In the setting of circulatory collapse, bedside echocardiography may be used to risk stratify these patients, based on the presence or absence of right ventricular dysfunction, and guide further management. Treatment options include anticoagulation alone, anticoagulation plus thrombolysis, surgical or catheter embolectomy. Inotropes, vasopressors and pulmonary artery vasodilators may be considered after initial resuscitation of the right ventricle. Few studies have focused on estimating the prevalence of PE among mechanically-ventilated intensive care unit (ICU) patients and there is notable lack of data assessing predictive factors, prevention, diagnostic strategy and management of PE in the ICU setting.

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“…6 In addition, PE can be found in about 50% of cases with deep vein thrombosis (DVT) and is usually asymptomatic, therefore increasing data support using bedside ultrasonography (US) as a noninvasive diagnostic tool. [7][8][9] In fact, bedside US is a rapid, safe, and potent diagnostic tool that can help physicians to evaluate their critical cases in a more accurate and timely manner. 7 Furthermore, it can be used at any time and place for patients regardless of the variables of age, pregnancy, kidney failure, or contrast allergy.…”

mentioning

confidence: 99%

“…In fact, bedside US is a rapid, safe, and potent diagnostic tool that can help physicians to evaluate their critical cases in a more accurate and timely manner. 7 Furthermore, it can be used at any time and place for patients regardless of the variables of age, pregnancy, kidney failure, or contrast allergy. 3,10…”

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confidence: 99%

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Evaluation of the Diagnostic Value of Bedside Transthoracic Ultrasonography (TTUS) and Lower Extremity Three-Points Compression Duplex in the Diagnosis of the Pulmonary Embolism

Golshani

Sharafsaleh

2020

Journal of Diagnostic Medical Sonography

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Background: The present study aimed at evaluating the diagnostic value of lung transthoracic ultrasonography (TTUS) and lower extremity sonography versus computed tomography pulmonary angiography (CTPA) in the diagnosis of pulmonary embolus (PE). Materials and Methods: This study was performed on 104 patients with clinically suspected PE. CTPA and D-dimer was performed on all patients. Wells’ deep vein thrombosis criteria (WDVTC) was evaluated and recorded at the patient’s admission. Finally, the results of adding venous and lung sonography scores to the WDVTC with and without the results of D-dimer test were analyzed for predicting the diagnosis of PE. Results: There were 104 patients clinically suspected of having a PE and enrolled in the study. A PE was confirmed in 37.5% of this cohort. WDVTC had a sensitivity and specificity of 94.87% and 80.00%, respectively, to predict PE. When adding D-dimer to the WDVTC for patients unlikely to have a PE (WDVTC≤4), the sensitivity and specificity of positive D-dimer in diagnosis of PE were 94.87% and 56.92%, respectively ( P < .001). Conclusion: According to these study results, the modification of the WDVTC along with the results of lung TTUS and lower extremity venous sonogram significantly increase the diagnostic power for PE.

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Diagnostic utility of color Doppler ultrasound in lower limb deep vein thrombosis in patients with clinical suspicion of pulmonary thromboembolism

Cited by 11 publications

References 14 publications

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

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

Pulmonary Embolism in the Mechanically-Ventilated Critically Ill Patient: Is it Different?

Evaluation of the Diagnostic Value of Bedside Transthoracic Ultrasonography (TTUS) and Lower Extremity Three-Points Compression Duplex in the Diagnosis of the Pulmonary Embolism

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