Pulmonary Embolism As a Consequence of Ultrasonographic Examination of Extremities for Suspected Venous Thrombosis: A Systematic Review

Abstract

Ultrasonographic examination for deep vein thrombosis (DVT) appears to be a safe diagnostic method, but a theoretical concern has been raised for dislodgment of thrombi during examination. We conducted a systematic review of the literature to identify reports of possible or confirmed pulmonary embolism (PE) as a consequence of ultrasonographic assessment of extremities in patients with suspected DVT. We searched PubMed for studies published in English from January 1, 1960, to April 10, 2015. We included all cohort studies, case series, and case reports that described PE as a consequence of ultrasonographic assessment of extremities. We excluded studies that reported assessment of areas other than extremities. We screened 3,626 articles, 15 of which reported the issue of clot dislodgement and embolization following ultrasonographic examination of the extremities, including 8 original case reports (7 men and 1 woman). DVTs were in the lower extremities in all eight cases: five in right and three in left lower extremity. In six cases, the femoral veins were involved, and a free-floating thrombus was reported in two cases. Compression ultrasonography was used in all cases, with or without adjunct techniques. Overall, there were seven confirmed and one probable PE cases, two of which had fatal outcomes. Clot embolization is a rare but potential complication of ultrasonic examination for DVT that can lead into PE. Radiologists and clinicians should be aware of this potentially serious phenomenon and avoid excessive pressure when performing ultrasonographic studies of the extremities.

Embolization of the Deep Vein Thrombus During Ultrasound Examination

“…Similar reports showed that the compression maneuver during ultrasound examination could be one of the contributory factors of thrombus dislodgment. Furthermore, free-floating thrombi or thrombi with free-floating tail in the right lower limb veins might have higher tendency for embolization ( 1 ).…”

Hemopericardium and Cardiac Tamponade as a Complication of Vena Caval Filters: Systematic Review of the Published Literature and the MAUDE Database

“…Systematic identification of safety events are challenging, with concern for missing relevant cases due to lack of reporting to regulatory bodies or the published literature or suboptimal indexing. 3,8 It is for this reason that even prior systematic reviews had missed several relevant cases. 3,9 This study had some limitations.…”

Diagnosis of Internal Jugular Vein Septic Thrombophlebitis by Point-of-Care Ultrasound

“…Once a thrombus is located, it is prudent to avoid repeat compression or investigation of the area. Although rare, case reports have proposed the association of venous ultrasound with embolic events, and this should be considered in any patient that develops cardiopulmonary symptoms during or after a positive examination 6 …”