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Emergency physician-performed compression ultrasonography focuses primarily on the evaluation of the proximal veins of the lower extremity in patients with suspected deep venous thrombosis (DVT). A detailed sonographic evaluation of lower extremity is not performed. The objective of this study was to determine the prevalence of non-thrombotic findi...
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A 43-year-old woman presented with localised areas of prominent, tender superficial veins in her right arm and both legs, and chest pain, following the second dose of AstraZeneca vaccine and possible contemporaneous Covid-19 infection. Electrocardiogram, troponin and d-dimer had all been normal. However, a venous duplex ultrasound scan showed a per...
Citations
... Particularly in the calves, DVT typically starts around the leaflets of venous valves and might advance superiorly. 2 The annual incidence is 1 per 1000 people worldwide. 3 After the age of 45 years, the incidence rises sharply, and the entry is closely correlated with the patient's age. 4 The main risk factors are surgery, trauma, pregnancy and puberty, immobility, hospitalization, hormone usage, cancer, obesity, and inherited and acquired hypercoagulable conditions. 5 A study in Saudi Arabia demonstrated that the most frequent contributing factors for lower limb DVTs were pregnancy and oral contraceptive use, trauma and surgery, and immobility. ...
Background
Deep vein thrombosis (DVT) is a common health problem. Accurate diagnosis of DVT is essential to avoid potentially fatal acute consequences of pulmonary embolism.
Aim
The study aims to assess deep venous thrombosis (DVT) of the lower limbs and to analyze the related risk factors.
Methods
This is a retrospective study including 60 patients who were examined using Triplex Doppler imaging. The patients were referred to the imaging departments with symptoms of lower limb DVT. The risk of DVT was expressed as an odds ratio (OR) with 95% confidence interval. Multiple logistic regression analysis was used to detect the independent risk factors. P value <0.05 was considered a significant statistic.
Results
Among the Saudi patients in Najran, acute DVT was more prevalent than chronic one (56.7% vs 38.3%), while subacute is less frequent (5%). DVTs are more prevalent in females than males (60% vs 40%) and most commonly affect patients older than 40. DVTs affect the left lower limb veins more than the right limb (75% vs 15%) and are less frequent on both sides (10%). The left popliteal vein (PV) and left common femoral vein (CFV) were the most common sites for acute DVTs. Binary logistic analysis revealed the independent risk factors for developing lower extremity DVT; malignancy (OR = 2.84, 95% CI = 0.518–15.513), surgery (OR = 2.66, 95% CI = 0.411–17.281), trauma (OR = 2.30, 95% CI = 0.452–11.658), and diabetes and hypertension (OR = 1.53, 95% CI = 0.335–6.969).
Conclusion
Acute lower limb DVT was more prevalent than chronic one. Malignancy, surgery, trauma, diabetes mellitus, and hypertension were the most common risk factors for lower limb DVTs. Left popliteal and left common femoral veins were the most common sites of acute DVTs.
... Venous duplex US has become the imaging modality of choice for the diagnosis of DVT due to its sensitivity and specificity [1]. Although used to diagnose DVTs, US often also identifies non-thrombotic pathology in the upper and lower extremities [2,3]. Data from large tertiary care facilities have shown that a large number of US used to detect DVTs diagnose non-thrombotic pathology as a cause for a patient's symptoms [2,3]. ...
... Although used to diagnose DVTs, US often also identifies non-thrombotic pathology in the upper and lower extremities [2,3]. Data from large tertiary care facilities have shown that a large number of US used to detect DVTs diagnose non-thrombotic pathology as a cause for a patient's symptoms [2,3]. Although data on the non-thrombotic findings on venous duplex US exist for tertiary care facilities, little to no data has been reported on the prevalence of and predictors for non-thrombotic findings venous duplex US at a community emergency department. ...
... Although data on the non-thrombotic findings on venous duplex US exist for tertiary care facilities, little to no data has been reported on the prevalence of and predictors for non-thrombotic findings venous duplex US at a community emergency department. Prior data on non-thrombotic findings also did not include findings from the upper extremities [2,3]. The authors sought to determine the prevalence and predictors of non-thrombotic findings following an initial venous duplex US of the upper and lower extremities at a community emergency department. ...
Background:
When used as a diagnostic aid for diagnosing deep vein thrombosis (DVT), venous duplex ultrasound (US) may reveal non-thrombotic findings in those with acute extremity pain. The objective of this study was to determine the prevalence and predictors of non-thrombotic findings on venous duplex US at a community emergency department.
Methods:
A retrospective chart review of all adult patients who presented to a community emergency department who underwent either an upper or lower extremity venous duplex US for the evaluation of DVT from June 1, 2019, to September 15, 2020. All US studies were completed by certified sonographers and interpreted by board-certified radiologists. Two trained research assistants manually abstracted patient demographics and US findings. Data were analyzed using the chi-square statistic for categorical variables and the student's independent t-test for continuous variables. Multivariate binomial regression was used to identify independent predictors of non-thrombotic results on venous duplex US.
Results:
A total of 1,448 venous duplex US were obtained during the study period with 126 DVTs being diagnosed. A total of 1071 US had no acute abnormality and 252 had non-thrombotic findings. All non-thrombotic findings were found in the lower extremity. Of those with non-thrombotic findings, the most common diagnoses included edema (34.9%, 88/252), Baker's cyst (22.6%, 57/252), and an unspecified fluid collection (16.3%, 41/252). Patients with non-thrombotic findings were more likely to have a history of atrial fibrillation (p=0.001) or hypertension (p=0.001), be older than the age of 70 (p=0.042), or have a history of using illicit drugs (p=0.003). Females were less likely to have non-thrombotic findings.
Conclusion:
In this single-site study, non-thrombotic findings were present in 23.5% of all venous duplex US completed at a community emergency department. These findings are more common in the elderly, those with cardiovascular disorders, and those who have used illicit drugs.
... We prefer to perform a whole-leg ultrasound in all patients with suspected acute DVT in our institution, conforming to current multidisciplinary guidelines [4]. The major advantage of this approach, in addition to detection of isolated calf DVT, is that it allows to identify alternative diagnoses which may have caused the patient's leg symptoms, thereby mimicking acute DVT [9][10][11][12]. ...
... Independent predictors of finding alternative diagnoses on whole-leg ultrasound were older age, leg swelling and a past history of DVT. Few prior studies have investigated alternative diagnoses in patients with suspected acute DVT found on whole-leg ultrasound examination [9,16,17]. In these studies, alternative diagnoses were observed less often with whole-leg ultrasound, (11% to 31% of all patients with suspected DVT) [9,16,17] as compared to our study (44%). ...
... Few prior studies have investigated alternative diagnoses in patients with suspected acute DVT found on whole-leg ultrasound examination [9,16,17]. In these studies, alternative diagnoses were observed less often with whole-leg ultrasound, (11% to 31% of all patients with suspected DVT) [9,16,17] as compared to our study (44%). In all of these studies, ultrasound scans were either performed by ultrasound technicians [16]/sonographers [17], or by vascular technologists and interpreted by vascular surgeons [9]. ...
Background
To investigate the prevalence, spectrum, and predictors of alternative diagnoses explaining leg symptoms in patients negative for suspected acute deep venous thrombosis (DVT), which can be detected with whole-leg ultrasound.
Methods
We retrospectively analyzed a cohort of 789 patients (median age 70 years, 50.6% women) evaluated with a whole-leg ultrasound examination for suspected acute DVT within one year. All findings in the radiology report were analyzed and electronic chart review was performed to collect clinical information.
Results
Ultrasound was negative for acute DVT in 531 patients (67.3%). Among these, alternative diagnoses explaining leg symptoms were seen in 349 patients (65.7%). The most frequent alternative diagnoses were chronic venous insufficiency (147 patients, 27.7%), followed by lymphedema (48 patients, 9.0%) and chronic post-thrombotic changes (41 patients, 7.7%). Patients with alternative diagnoses were older (median 71 vs. 66 years, p = 0.0226), as well as more likely to present with leg swelling (39.5% vs. 23.1%, p = 0.0002), difference in leg circumference (25.5% vs. 14.8%, p = 0.0055) and redness (7.7% vs. 2.7%, p = 0.0213) than patients without alternative diagnosis. Independent predictors of finding alternative diagnoses on whole-leg ultrasound were older age (odds ratio 1.014 per year, p = 0.0119), leg swelling (OR 1.949, p = 0.0020) and history of previous DVT (OR 2.235, p = 0.0154).
Conclusions
Alternative diagnoses explaining leg symptoms can be detected on whole-leg ultrasound in two thirds of patients with no evidence of acute DVT. Our data supports performing a comprehensive ultrasound evaluation beyond the venous system, particularly, in older patients, who present with leg swelling and a past history of DVT.
Point-of-care ultrasound for the assessment of leg pain and swelling is a rapid, high-yield assessment that can quickly lead to therapeutic interventions. Ultrasound of the lower extremity can be used to assess for deep venous thrombosis (DVT), lymphadenopathy, and visualization of subcutaneous edema for evaluation of cellulitis versus congestive heart failure (CHF). As most pathology in the lower extremity is relatively superficial, a high-frequency linear transducer is used for its superior linear resolution and flat footprint.
