Venous Thrombosis in Suspected Pulmonary Embolism: Incidence Detectable by Doppler Ultrasound^[*]

Summary

Doppler ultrasound has been used to screen patients for venous thrombosis with an accuracy of 94% compared to venography. Of 168 patients with suspected pulmonary embolism, only 48 (28%) had a source of venous thrombosis detectable by Doppler examination. The calf and iliofemoral venous segments were the two most common sites of involvement. When compared to Doppler examination, clinical assessment of the legs was falsely negative in 15% and falsely positive in 54% of patients. The highest incidence of venous thrombosis detected by Doppler examination (49%) was in the group of patients with a positive lung scan and a normal chest film. Doppler evidence of venous thrombosis was present in only 21% of patients with both a positive scan and an abnormal chest film. One-third of the patients with suspected pulmonary embolism had a negative lung scan. The most common conditions mimicking pulmonary embolism were congestive heart failure, pneumonia, chronic lung disease and atelectasis. Patients with suspected pulmonary emboli frequently have no demonstrable source of thrombosis and may deserve more thorough angiographic evaluation for proper diagnosis and therapy.

^* Presented in part at the Society for Thrombosis and Haemostasis, Dallas, Texas, U.S.A., November 20-22, 1974.

• References

• 1 Barnes R. W, Russell H. E, Wilson M. R. 1974. Doppler Ultrasonic Evaluation of Venous Disease: A Programmed Audiovisual Instruction. The University of Iowa; Iowa City, Iowa.:
• 2 Coon W. W, Coller F. A. 1959; Clinicopathologic correlation in thromboembolism. Surgical Gynecology and Obstetrics 109: 259.
• 3 Freeark R. J, Bostwick J, Fardin R. 1967; Posttraumatic venous thrombosis. Archives of Surgery 95: 567.
• 4 Gibbs N. M. 1957; Venous thrombosis of the lower limbs with particular reference to bedrest. British Journal of Surgery 45: 15.
• 5 Haeger K. 1969; Problems of acute deep venous thrombosis. Angiology 20: 219.
• 6 Lea Thomas M, Browse N. L. 1972; Internal iliac thrombosis. Acta Radiologica 12: 660.
• 7 McLachlin J, Paterson J. C. 1951; Some basic observations on venous thrombosis and pulmonary embolism. Surgical Gynecology and Obstetrics 93: 1.
• 8 Mavor G. E, Galloway J. M. D. 1967; The iliofemoral venous segment as a source of pulmonary emboli. Lancet 1: 871.
• 9 Poe N. D, Dore E. K, Swanson L. A, Taplin G. V. 1967; Misinterpretation of lung scans in the diagnosis of pulmonary embolism. Journal of Nuclear Medicine 8: 345.
• 10 Sevttt S, Gallagher N. G. 1961; Venous thrombosis and pulmonary embolism. A clinico-pathological study in injured and burned patients. British Journal of Surgery 48: 475.
• 11 Silver D. 1974; Pulmonary embolism. Prevention, detection and non-operative management. Surgery Clinics of North America 54: 1089.
• 12 Sumner D. S, Baker D. W, Strandness D. E. 1968; The ultrasonic velocity detector in a clinical study of venous disease. Archives of Surgery 97: 75.