Diagnosis of Venous Thromboembolic Disease

ABSTRACT

Venous thromboembolic disease (VTD), comprising deep venous thrombosis (DVT) and pulmonary embolism (PE), is a major cause of morbidity and mortality throughout the world. Anticoagulation has been demonstrated to be beneficial in the treatment of VTD, but it is not without its risks. Thus, definitive diagnosis of DVT and PE should be obtained prior to initiation of anticoagulation. Because clinical examination is insufficient for the diagnosis of VTD, it must be supplemented by serologic or imaging studies, or both. D-Dimer assays, when negative, may help to exclude VTD. Doppler ultrasound examination may reliably diagnose femoropopliteal thrombus. The diagnosis of PE should be based on detailed clinical examination followed by appropriate studies, including chest radiography, electrocardiography, ventilation/perfusion (V/Q) lung scintigraphy, and, if those studies are inconclusive, pulmonary arteriography. The use of spiral computed tomography in the diagnosis of PE is undergoing evaluation and may prove useful in the diagnostic algorithm; however, its current sensitivity (approximately 85% for segmental and larger emboli) weighs against its widespread use as the final diagnostic modality. The current evaluation of VTD is discussed, and a diagnostic algorithm is proposed here.

KEYWORD

Deep vein thrombosis - pulmonary embolism - anticoagulation

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