Abstract
CONTEXTO: Apesar de a ultrassonografia vascular com Doppler colorido (UVDC) ser confiável na avaliação de TVP em membros inferiores, situações como variações anatômicas das veias tibiais podem limitar o diagnóstico ou mesmo induzir a um resultado falso-positivo. OBJETIVO: Apresentar uma variação anatômica das veias tibiais posteriores potencialmente responsável por resultados falso-positivos no diagnóstico da TVP antiga pela UVDC. MÉTODOS: Foram revisados exames de UVDC em pacientes com suspeita de trombose venosa profunda de membros inferiores realizados no período de janeiro a dezembro de 2012. Nestes, foram observados a presença, o número e o trajeto das veias profundas, e suas respectivas artérias. Os casos suspeitos de variação anatômica nas veias tibiais posteriores foram revisados por outro ultrassonografista vascular, para confirmação dos achados. A variação anatômica com agenesia ou hipoplasia das veias tibiais posteriores foi considerada somente quando a artéria tibial posterior também não foi identificada em toda a extensão ou nos respectivos segmentos nos quais não foram visibilizadas as veias. RESULTADOS: Foram realizados 1458 estudos pela UVDC em pacientes com suspeita de TVP em membros inferiores. Em seis pacientes (0,41%), houve agenesia parcial ou completa das veias tibiais posteriores. Cinco pacientes tiveram avaliação unilateral e um bilateral, totalizando sete membros inferiores, três membros inferiores direitos e quatro esquerdos. CONCLUSÃO: Apesar de encontrada em apenas 0,41% dos casos, o conhecimento da agenesia das veias posteriores é útil, a fim de diminuir erros diagnósticos e resultados falso-positivos para TVP em pacientes com essas variações.
Highlights
Color Doppler ultrasound (CDUS), the method of choice to investigate the natural history of deep vein thrombosis (DVT) and establish its diagnosis, has a sensitivity of 97% and specificity of 94% when compared with phlebography[1,2,3]
This study described an anatomic variation of posterior tibial veins that might lead to false positive results in the color Doppler ultrasound (CDUS) diagnosis of chronic DVT
In the 1458 venous studies, absence or aplasia of posterior tibial veins was detected in six patients (0.41%): five unilateral scans and one, bilateral, at a total of seven lower extremities
Summary
Color Doppler ultrasound (CDUS), the method of choice to investigate the natural history of deep vein thrombosis (DVT) and establish its diagnosis, has a sensitivity of 97% and specificity of 94% when compared with phlebography[1,2,3].A diagnosis of DVT is made when CDUS identifies deep vessels, determines their compressibility and detects flow or echogenic images in their lumen.Recent DVT is diagnosed when CDUS detects an increase in the diameter of the vein in comparison with the artery, which may be semi- or noncompressible, and echogenic and predominantly hypoechoic images that fill the vein lumen partially or totally, as well as partial or no flow. Even though color Doppler ultrasound (CDUS) imaging is reliable in assessing deep vein thrombosis (DVT) in lower extremities, anatomical variations of tibial veins may limit the diagnosis and even lead to false positive results. Objective: To describe anatomic variations of the posterior tibial vein that may lead to false positive results in the CDUS diagnosis of chronic DVT. Methods: CDUS scans of patients with suspected deep vein thrombosis of the lower extremities obtained from January to December 2012 were reviewed to record the presence, number and course of deep veins and arteries. Results: A total of 1458 CDUS scans of patients with suspected DVT in the lower extremities were reviewed. Conclusion: a rare condition, found in only 0.41% of the cases, awareness of posterior vein absence may help to avoid misdiagnoses and false-positive results of DVT in patients with this variation
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