Color doppler ultrasound parameters of deep vein thrombosis of lower limbs may predict the severity of lung perfusion impairment of pulmonary embolism and the level of its mortality risk

Abstract

Purpose: This study evaluated if the color doppler ultrasound (CDU) parameters such as location, extention and adhesion of thrombi of Deep Vein Thrombosis (DVT) of the lower limbs are predictive of Pulmonary Embolism (PE) complication and its gravity. The latter was assessed on clinical evaluations and imaging including pathognomonic symptoms (dyspnea, thoracic pain and syncope), perfusion lung scans and mortality risk. Methods: 224 patients (pts) diagnosed of PE were subjected to lower limb deep vein CDU and perfusion lung scan within 5 days from admission. The sample was divided into 4 categories by the presence or absence of DVT and its position. The presence or absence of symptoms at the PE emergence, the average Perfusion Damage Index for each category as well as the early mortality risk (calculated on the base of right ventricular disfunction using echocardiography and/or miocardial injury marker based on European Society of Cardiology 2008 guidelines) were also considered. Moreover cancer pts (n° 101, 45%) were evaluated indipendently, as well as pts with freefloating thrombus (FFT) proximal DVT. Results: See Table 1. View this table: Table 1 Conclusions: Pts without DVT had similar clinical and imaging PE results compared to pts with DVT. Distal DVT has less risk and gravity of PE compared to the Proximal DVT, whereas in the FFT and bilateral cases the gravity is higher. We can conclude that neoplasms are the most frequent causes of secondary venous thromboembolic disease, particularly in pts with bilateral DVT as well as in pts without DVT. In our study also emerged that cancer pts are prevalently asymptomatic at onset of PE.