Clinical presentation of isolated calf deep vein thrombosis in inpatients and prevalence of associated pulmonary embolism

Abstract

ObjectiveControversy exists regarding the clinical significance and optimal treatment of isolated calf deep vein thrombosis (DVT). In the present study, the clinical presentation of isolated calf DVT and the association of isolated calf DVT with pulmonary embolism (PE) in hospitalized patients were investigated. MethodsA total of 1435 hospitalized patients had undergone whole leg duplex ultrasound between January 2018 and June 2020. Isolated calf vein DVT was diagnosed in 135 of these 1435 patients. ResultsThe soleal vein was the most frequently involved (52.6%). Thrombus was detected only in the axial veins in 57 patients (42.2%), muscular veins in 46 patients (34.4%), and both axial and muscular veins in 32 patients (23.7%). Of the 135 patients, 44 (32.6%) had undergone recent orthopedic surgery, 31 (23.0%) had active cancer, and 22 (16.3%) had a history of recent stroke. The reasons for duplex ultrasound examination were leg edema and/or pain for 57 patients (42.2%), the diagnosis of PE for 33 (24.4%), and an elevated D-dimer level for 27 patients (20.0%). For 16 patients (11.9%), DVT had been diagnosed as an incidental finding on imaging studies performed for other purposes. Of the 135 patients, 96 (71.1%) had received anticoagulation therapy. Concurrent PE was diagnosed in 45 patients (33.3%), 14 of whom had had lesions in the main pulmonary artery. Of the 45 patients with concurrent PE, 35 had not experienced leg edema and/or pain. Recurrent venous thromboembolism was observed in four patients (3.0%) at a mean follow-up of 15.5 ± 12.7 months. ConclusionsIn the present study, isolated calf DVT was associated with a high prevalence of PE in the hospitalized patients. Patients with isolated calf DVT, even without leg edema and/or pain, could have concurrent PE. Anticoagulation therapy should be considered for inpatients with isolated calf DVT. The muscular veins were frequently involved and, thus, should be thoroughly evaluated with imaging studies.