Systematic study of occult pulmonary thromboembolism in patients with deep venous thrombosis

Abstract

Silent PTE occurred frequently in association with clots of lower limbs. The CT scan had a good availability and cost-effectiveness to detect clinically underestimated PTE. The incorporation of this exploration in the systematic diagnostic strategy of most patients with DVT to establish the extension of thromboembolic disease at diagnosis may be useful in the evaluation of added pulmonary artery symptoms and treatment strategies.

Relationship between the extent of deep venous thrombosis and the extent of acute pulmonary embolism as assessed by CT angiography

“…This may be different from other studies and could be explained by our recruitment process: patients in Group 1 had no dyspnoea or pulmonary symptoms and those in Group 2 had positive CTPA. However, our results are in line with previous studies that have reported clinically unsuspected PE in 34-58% of patients with acute DVT, regardless of the imaging technique used [2,6,[15][16][17][22][23][24][25][26], and a prevalence of DVT in 72-82% of patients with clinically suspected/confirmed PE [1,4,27]. The relationship between the location of the upper end of the venous clot in the lower limbs and the frequency of associated PE, however, remains controversial.…”

“…Indeed, Girard et al [4] reported no relationship between the Miller score and the anatomical level of the upper end of the clot in lower limb veins. Similarly, Lopez-Beret et al [6] found that, in patients with proximal DVT (i.e. within the iliofemoral and/or femoropopliteal veins), the number of pulmonary segments affected by PE is not any higher than in patients with more distal DVT.…”

“…The relationship between the location of the upper end of the venous clot in the lower limbs and the frequency of associated PE, however, remains controversial. Some authors have reported that the risk of PE is higher for proximal DVT than for distal DVT [22,23], but others have not reported such a relationship [6,[24][25][26].…”

“…As pointed out by several investigators, thrombotic disease can be treated inappropriately: silent PE can go unnoticed and, as a consequence, can be treated insufficiently or, when mistaken to have progressed from ineffective DVT treatment, can result in an overly aggressive or unnecessary change in treatment [2,6,[15][16][17]. Girard et al [4] have shown that the probability of PE is closely correlated to the extent of DVT in lower limb veins, and the greater the extent of PE, the higher the probability of residual DVT.…”

“…Venous thromboembolic disease comprises pulmonary embolism (PE) and deep venous thrombosis (DVT) [1][2][3][4][5][6][7][8][9][10][11][12]. A patient may present with either of these conditions, or both, and may not always exhibit the signs of one condition.…”