Evaluation Of Deep Venous Thrombosis Research Articles

Magnetic resonance (MR) evaluation of deep venous thrombosis of 338 discharged viral pneumonia patients.

Viral pneumonia (VP) often leads to the development of deep vein thrombosis (DVT) in hospitalized patients. The aim of the study was to investigate the incidence of DVT in discharged patients with VP, and whether new and old DVT differ in transverse relaxation time. In this prospective cohort study in Wuhan, China, 338 consecutive discharged VP patients from February 2021 to March 2023 who underwent T2 weighted Sampling Perfection with Application Optimized Contrast Evolution (SPACE) were recruited to detect DVT. T2 mapping and T2* mapping were performed for the patients with DVT detected by magnetic resonance imaging (MRI). The minimum, maximum, mean of T2 time and T2* time of DVT were recorded as T2min, T2max, T2mean, T2*min, T2*max, and T2*mean, respectively. Clinical data and laboratory findings were compared between new and old DVT cases, which were defined based on the examination results before and after discharge. A Mann-Whitney test was used to compare transverse relaxation time parameters between new and old DVT. Twelve percent of VP patients (40/338) developed new DVT after discharge. Thirty-three out of 104 DVTs did not resolve after discharge. Compared with patients with new DVT, patients with old DVT were older (67 vs. 59 years, P=0.003); and had a higher proportion of bedridden time >72 hours (72.7% vs. 37.0%, P<0.001). Patients with old DVT had a lower lymphocyte count (0.67×109/L vs. 0.97×109/L, P=0.01), higher C-reactive protein (59 vs. 35 mg/L, P=0.019), and higher levels of D-dimer (6.7 vs. 0.9 µg/mL, P<0.001) than patients with new DVT. Patients with old DVT received more invasive mechanical ventilation (30.3% vs. 7.4%, P<0.001) and had a higher proportion of acute respiratory distress syndrome (75.8% vs. 51.9%, P<0.001), and a higher proportion of cardiac injury (39.4% vs. 14.8%, P=0.033) than patients with new DVT. T2min, T2max, T2mean, and T2*max of new DVT were significantly greater than old DVT (17.6±10.4 vs. 13.2±5.9 ms, 94.9±44.9 vs. 42.3±23.6 ms, 46.8±24.0 vs. 25.0±12.6 ms, 22.5±12.4 vs. 10.7±3.5 ms, P<0.05 for all). There was no significant difference in T2*min or T2*mean between new and old DVT (3.2±0.4 vs. 3.1±0.4 ms, 8.2±4.9 vs. 5.5±1.5 ms, P>0.05 for both). T2 weighted SPACE magnetic resonance (MR) is valuable in the follow-up of thrombosis of discharged VP patients. T2 mapping distinguishes between new and old DVT.

Role of Imaging in Evaluation of Deep Venous Thrombosis and Pulmonary Embolism in COVID-19 Patients

Role of Imaging in Evaluation of Deep Venous Thrombosis and Pulmonary Embolism in COVID-19 Patients

Does point-of-care ultrasound have patient-care advantages over ultrasound performed in the radiology department in the evaluation of deep venous thrombosis?

Does point-of-care ultrasound have patient-care advantages over ultrasound performed in the radiology department in the evaluation of deep venous thrombosis?

Isolated Deep Venous Thrombosis: Implications for 2-Point Compression Ultrasonography of the Lower Extremity

Two-point compression ultrasonography focuses on the evaluation of common femoral and popliteal veins for complete compressibility. The presence of isolated thrombi in proximal veins other than the common femoral and popliteal veins should prompt modification of 2-point compression technique. The objective of this study is to determine the prevalence and distribution of deep venous thrombi isolated to lower-extremity veins other than the common femoral and popliteal veins in emergency department (ED) patients with clinically suspected deep venous thrombosis. This was a retrospective study of all adult ED patients who received a lower-extremity venous duplex ultrasonographic examination for evaluation of deep venous thrombosis during a 6-year period. The ultrasonographic protocol included B-mode, color-flow, and spectral Doppler scanning of the common femoral, femoral, deep femoral, popliteal, and calf veins. Deep venous thrombosis was detected in 362 of 2,451 patients (14.7%; 95% confidence interval [CI] 13.3% to 16.1%). Thrombus confined to the common femoral vein alone was found in 5 of 362 cases (1.4%; 95% CI 0.2% to 2.6%). Isolated femoral vein thrombus was identified in 20 of 362 patients (5.5%; 95% CI 3.2% to 7.9%). Isolated deep femoral vein thrombus was found in 3 of 362 cases (0.8%; 95% CI -0.1% to 1.8%). Thrombus in the popliteal vein alone was identified in 53 of 362 cases (14.6%; 95% CI 11% to 18.2%). In our study, 6.3% of ED patients with suspected deep venous thrombosis had isolated thrombi in proximal veins other than common femoral and popliteal veins. Our study results support the addition of femoral and deep femoral vein evaluation to standard compression ultrasonography of the common femoral and popliteal vein, assuming that this does not have a deleterious effect on specificity.

Preoperative evaluation of deep venous thrombosis in patients with pelvic organ prolapse.

The incidence of preoperative deep venous thrombosis (DVT) was examined in patients with pelvic organ prolapse (POP). Preoperative screening for DVT was performed on the basis of D-dimer levels; if D-dimer levels were beyond the cut-off limit (0.5 μg/mL), ultrasound examination of the lower extremities was performed. A total of 75 consecutive patients who were scheduled for POP operation in our department were examined retrospectively. D-dimer levels were elevated in 24 patients (31.6%). Further, DVT was detected in 10 of the 75 patients, resulting in an incidence rate of 13.3% in the present study. D-dimer levels were significantly higher in the patients with DVT (1.25 ± 0.52 μg/mL vs 0.41 ± 0.26 μg/mL). There was no significant difference in age, and although body mass index and the number of diabetes mellitus cases were relatively higher in the patients with DVT than in those without DVT, there were no statistically significant differences. According to a receiver-operator curve, the suggested cut-off D-dimer value was 0.71 μg/mL (sensitivity and specificity was 0.9 and 0.877, respectively). Although this was a preliminary study, to the best of our knowledge, this is the first report describing the incidence of preoperative DVT in patients with POP. Our study indicates that the incidence of DVT in patients with POP might have been underestimated thus far. Therefore, every surgeon should evaluate patients for DVT prior to any surgical procedure for POP, particularly in those patients with obesity or diabetes mellitus.

Abstract W MP64: Evaluation of Deep Venous Thrombosis in Cryptogenic Stroke and Patent Foramen Ovale

Background and Purpose: In cryptogenic stroke (CS), paradoxical embolus has been suggested as a stroke mechanism. A prior study found a significant rate of pelvic deep venous thrombosis (DVT) using magnetic resonance venography (MRV). We sought to evaluate the yield of diagnostic tests for lower extremity (LE) and pelvic DVT in stroke patients with patent foramen ovale (PFO) and in the subset with CS. Methods: A single center retrospective study was performed to identify consecutive ischemic stroke or TIA patients with PFO who underwent contrast-enhanced 3D pelvic MRV imaging (Ablavar, Lantheus Medical Imaging, N. Billerica, MA) between 2009 and 2013 as part of an inpatient diagnostic evaluation. Results of pelvic MRV, LE Doppler ultrasound (US) as well as clinical data were abstracted. Ischemic subtype was retrospectively assigned using the Causative Classification System (CCS). Patients with possible cardio-aortic embolism and undetermined cause by CCS were classified as CS. We estimated point estimates and 95% confidence intervals (CI) for DVT prevalence among stroke subtypes using the Wald method and compared these using Chi-square tests. Results: Of 130 patients who met study criteria, mean age was 56 +/- 17 years and median time from admission to MRV was 2 days (IQR 1-3). Overall DVT prevalence was 7.7% (95% CI, 4.1 to 13.7); the prevalence of pelvic DVT was 1.6% (95% CI, 0.07 to 5.8) and that of LE DVT was 7.2% (95% CI, 3.7 to 13.3). Of the patients with pelvic DVT (n=2), one patient also had a LE DVT by US. When MRV or US was obtained within 72 hours following admission, the prevalence of pelvic DVT was 2.1% (95% CI, 0.12 to 7.7) and that of LE DVT was 7.8% (95% CI, 3.8 to 14.8). Comparing patients with CS (n=97) to other subtypes (n=33), there was no difference in the prevalence of pelvic DVT (2.1% vs. 0%, P=1), LE DVT (6.3% vs. 10.3%, P=0.43) or any DVT (7.2% vs. 9.1%, P=0.71). Conclusion: Patients with CS and PFO have similar prevalence of DVTs compared to other stroke subtypes. The majority of detected DVTs were in LE veins rather than pelvic veins. Only a single patient with a pelvic DVT did not have a coexistent LE DVT. Our results suggest that the utility of pelvic MRV may be much lower than previously reported.

Musculoskeletal ultrasonography of the lower extremities in infants and children

Ultrasonography is a powerful diagnostic imaging tool for evaluating lower extremity anatomy and pathology in children. Indications for pediatric musculoskeletal lower extremity sonography include developmental dysplasia of the hip, hip joint sonography for the child with a painful hip, evaluation and characterization of superficial soft-tissue masses, evaluation for deep venous thrombosis, and foreign body localization, characterization and removal. This review highlights these established indications, but primarily focuses on additional US applications for evaluation of the lower extremities, including diagnosis and characterization of arthritis and monitoring of therapy, evaluation of tendon tears and muscle strain injuries, characterization of soft-tissue masses and evaluation of certain congenital abnormalities of the lower extremities. Techniques for optimal utilization of musculoskeletal US in children are also discussed.

A Rare Report of Mediastinal Liposarcarma Diagnosed by Endoscopic Ultrasound-Guided Fine-Needle Aspiration (EUS-FNA)

Purpose: Introduction: Soft tissue sarcomas are a rare group of malignancies, accounting for less than 1% of all adult malignancies. Liposarcoma is a small subset of these, with mediastinal liposarcoma rarely reported, especially in the absence of a known primary tumor or prior history of liposarcoma. This tumor has varying response to treatment, and prognosis is highly dependent upon the level of differentiation, thus obtaining an accurate and definitive biopsy is a crucial diagnostic step. EUS-FNA is frequently and reliably used as a modality for a multitude of clinical situations, however there are no prior reports of EUS-FNA used to diagnose mediastinal liposarcoma preoperatively. Case: A 56-year-old male with an incidental finding of a large posterior mediastinal mass during evaluation for deep venous thrombosis. CT scan of the chest revealed a 12.6 x 7.3 x 11.3 cm soft tissue mass, heterogeneous, with well-circumscribed borders, without evidence of direct invasion of the adjacent heart. Both the heart and esophagus shared a border with the mass, as did the thoracic aorta. PET-CT subsequently revealed mild FDG uptake within the mass, without other noted abnormality. The patient was referred for EUS-FNA biopsy of the posterior mediastinal mass. EUS revealed an irregular, poorly defined mass. The mass was notably hyperechoic with fatty echogenicity, however there was a focal area of hypoechogenicity within the larger mass. A total of seven fine needle aspirations were obtained via transesophageal approach, with tissue specimens obtained from both the hyper- and hypoechoic areas. Preliminary cytology from the hypoechoic areas revealed tissue highly suspicious for sarcomatous neoplasm. Immunohistochemistry performed on the specimens obtained revealed neoplastic cells immunoreactive for MDM2, CDK4, S100 and Vimentin, consistent with liposarcoma. Subsequent FISH analysis was confirmatory of liposarcoma and consistent with a well differentiated tumor. The patient did undergo further confirmatory testing to include left video-assisted thorascopy with core biopsy of the mediastinal mass, which confirmed the findings from EUS-FNA of well differentiated liposarcoma. Discussion: To our knowledge, this is the first case of mediastinal liposarcoma definitively diagnosed by EUS-guided FNA. Given the grave implications in treatment and prognosis hinging on accurate grading of these tumors, a non-surgical procedure to obtain this information is vital. This case demonstrates that EUS-FNA is a useful and practical modality for diagnostic evaluation of a suspected mediastinal soft tissue tumor.

Evaluation of deep venous thrombosis in lower extremities using 64-slice spiral CT venography and curved planer reconstruction

Objective To explore the value of multi-slice spiral CT venography (MSCTV) and curved planer reconstruction (CPR) in diagnosis of deep venous thrombosis (DVT) in lower extremities. Methods MSCT was pedormed in 19 patients with DVT in lower extremities, with scanning ranging from the anterior superior lilac spine to the ankle. The constrnst medium was injected via the cubital vein. Scanning started with Smart Prep scanning model when the inferior vena density reached 100 Hu. Common iliac veins, external iliac veins, femoral veins, pepliteal veins and posterior tibial veins were reconstructed with CPR post-processing software. We obtained diagnosis from CPR images combined with volume rendering (VR), multi-plannar reconstruction (MPR) and raw data, and MSCTV results of nine patients were compared with color Doppler ultrasonography. Results MSCTV clearly demonstrated all 259 segments of deep veins of lower extremity in 19 patients, of which 73 segments had DVT. All target vessels were clearly displayed on CPR images except for posterior tibial veins. Vein thrombosis presented double track sign , irregular narrowing or obstruction on CPR images. The transverse diameter of the lumens was larger than that of the normal ones (P<0.05 ). Conclusion MSCTN and CPR have many advantages and can be used as a routine method in the diagnose of DVT. Key words: Venous thrombosis; Tomngraphy; spiral computed; Angiocardingrahy; Curved planer reconstruction

The Importance of Monophasic Doppler Waveforms in the Common Femoral Vein

The purpose of this study was to assess the importance of monophasic waveforms encountered in the common femoral vein during deep venous thrombosis evaluation by a retrospective review of lower extremity venous Doppler (VD) sonography and correlative studies, such as computed tomography (CT) and magnetic resonance imaging. A retrospective review was conducted of lower extremity VD studies performed from September 1, 2000, through September 1, 2005. All satisfactory VD studies, which were in compliance with the Intersocietal Commission for the Accreditation of Vascular Laboratories standard protocol, were evaluated for the presence of monophasic waveforms and correlated with CT of the abdomen and pelvis. Studies were evaluated for the causes of monophasic waveforms. Patients younger than 18 years were excluded. A total of 2963 VD examinations were reviewed. One hundred twenty-four of 2963 showed monophasic waveforms. Eighty-nine of the 124 had additional CT examinations within 1 week; 19 had CT within 2 months; and 16 had no additional examinations. Forty-seven of 124 cases revealed deep venous thrombosis extending into the iliac veins, of which 23 were identified by VD sonography; 26 were due to extrinsic compression; 6 showed a hypoplastic or stenosed common iliac vein; and the remaining 45 had no apparent causes for the monophasic waveforms. Monophasic waveforms in the common femoral veins are reliable indicators of proximal venous obstruction. Because iliac vein thrombosis is clinically important, we recommend routine sonographic evaluation of external iliac veins in the presence of monophasic waveforms and CT or magnetic resonance imaging, if necessary, to determine the cause of the monophasic waveforms.

3556: Application of elasticity imaging to evaluation of deep venous thrombosis: Preliminary study

We have developed a real-time tissue elastography for visualizing the tissue hardness/softness to detect lesions such as cancer. We have been investigating its clinical usefulness for several clinical abnormalities, e.g., breast cancer, prostate cancer, thyroid cancer and plaque hardness/softness. In this paper we applied our real-time tissue elastography to the diagnosis of deep venous thrombosis (DVT). DVT is known to cause pulmonary thromboembolism (PTE) and needs early detection and treatment especially when it is in acute stage.

Deep venous thrombosis: clinically silent in the intensive care unit

Purpose The reliability of clinical signs and the physical examination in the evaluation of deep venous thrombosis (DVT) in the critically ill is unknown. The purpose of this study was to determine the diagnostic properties of clinical examination for signs of DVT in a cohort of medical-surgical intensive care unit (ICU) patients using screening compression ultrasonography as a reference standard. Materials and Methods We prospectively included patients older than 18 years with an expected length of ICU stay of more than 72 hours. Patients underwent bilateral lower limb screening compression ultrasound twice weekly and structured physical examination twice weekly by 2 independent trained research coordinators blinded to the ultrasonography results. We classified patients according to 2 methods: method 1, a DVT Risk Stratification System of 3 categories and method 2, a DVT Risk Score, both of which use the history and physical examination to stratify patients for their risk of DVT. Results We included 239 patients in our study, 32 of whom had DVT based on the results of their compression ultrasound. We excluded 7 patients with DVT on ICU admission and 2 who did not undergo any structured examinations. We matched controls with cases (9:1) based on duration of ICU stay. Cases and controls were then allocated to low, moderate, and high risk strata for DVT. Using method 1, the area under the receiver operating characteristic curve (AUC) was 0.57 (95% CI, 0.33-0.78, P = .01). Using method 2, the AUC was 0.59 (95% CI, 0.42-0.75, P = .02). An AUC of 1.0 indicates an ideal test, and AUC of 0.50 indicates a test with no diagnostic utility. Conclusions The history and physical examination for DVT are not useful in detecting lower limb DVT in the ICU.

Neovascularization in acute venous thrombosis

The aim of this study was to describe the phenomenon of arteriovenous fistula (AVF) formation in venous thrombus. Patients referred to the vascular laboratory for evaluation for deep venous thrombosis were included. Duplex ultrasound scanning was used to detect flow within the thrombus. The flow patterns and the resistivity index were obtained in the veins above/proximal and below/distal to the thrombus, in the adjacent arteries, and within the perivenous vessels. Patients with trauma, hemodialysis access, endovenous ablation, known AVF, or inflammatory conditions were excluded. There were 22 patients with AVF flow in thrombosed veins. Deep veins were involved in 15 cases and superficial veins in the remainder. Perivenous vessels feeding the AVF in the thrombus could be clearly identified in 16 patients (19 vein segments). In 21 of 22 patients, multiple flow channels were present throughout the involved thrombosed vein segment. These flow channels were isolated to a single vein segment. They measured <4 cm in length in 19 cases and were more extensive in the remaining three. Reflux within the vein segment was identified in 13 cases. Local symptoms that could be attributed to the arterialization of thrombosed veins occurred in four cases, and none of the patients manifested systemic symptoms. The flow within the thrombus had high end-diastolic velocities with a mean resistivity index of 0.48 (SD, 0.08), which is typical of a fistula flow pattern. The flow in the main arteries was unaffected. Neovessels were found with AVF flow in thrombi of superficial and deep veins. They had variable length and multiple flow channels, with inflow from perivenous arteries. The flow in the adjacent main arteries was not affected, and no systemic symptoms were detected. The exact etiology and natural history of this phenomenon are not known, and its clinical significance is unclear.

Resident-Performed evaluation for deep venous thrombosis reduces time to diagnoses “After-Hours”

Study objectives: The vascular laboratory may not be available 24 hours a day to evaluate patients with suspected lower extremity deep venous thrombosis (DVT). We assess the impact of resident-performed compression ultrasonography on the time to diagnosis for patients treated “after hours” with suspected DVT. Methods: This was a prospective study of patients treated after hours with suspected DVT during a 6-month period in an urban, academic emergency department (ED). Patients were enrolled only when a study physician was available in the ED. Informed consent and compression ultrasonography without color Doppler were done by 1 of 8 participating resident sonographers not responsible for the care of the patient. Treating clinicians were blinded to the results of this examination and determined treatment course with private physicians when available. Results: Forty-eight patients were enrolled with suspected DVT and underwent resident-performed compression ultrasonography for DVT before evaluation by the vascular laboratory. There were 23 true positives, 1 equivocal examination considered a “false positive” for the sake of analysis, 24 true negatives, and no false negatives, corresponding to a sensitivity of 100% (95% confidence interval [CI] 82% to 100%) and specificity of 96% (95% CI 78% to 100%) for lower extremity DVT. Eleven patients were admitted, presumptively anticoagulated, and had inpatient evaluation by the vascular laboratory an average of 23 hours (95% CI 14.2 to 32) after compression ultrasonography in the ED. Thirty-seven patients were held overnight in the ED and underwent vascular laboratory evaluation an average of 7.7 hours (95% CI 5.3 to 10.2) after compression ultrasonography in the ED. Discussion: Our only equivocal examination occurred in a patient with tender lymphadenopathy caused by unilateral cellulitis, preventing the resident from performing adequate compression pressure for an adequate examination. Conclusion: Resident-performed compression ultrasonography for DVT was accurate and associated with a decrease in time to diagnosis for patients treated after hours.

D-Dimer as a Screening Tool for Ultrasound Examination for Diagnosis of Deep Vein Thrombosis

Ultrasound (US) examinations have become the standard for evaluation of deep venous thrombosis (DVT). Evaluation for a possible DVT constitutes more than 40% of the daily ultrasound examinations performed at St. John's Regional Health Center. Of the US examinations performed for DVT, 80% are negative. The addition of D-dimer testing to the diagnostic algorithm has the potential to make the diagnosis of DVT in outpatients more convenient and economical. Ultrasound examination and interpretation is expensive. This project was to evaluate the D-dimer determination as a screening tool to indicate the need for US evaluation for DVT. The focus of this evaluation was the negativity of the D-dimer as a predictor of a normal venous examination. This study found that with a negative D-dimer result, more than 90% of the venous examinations were negative for DVT.

Accuracy of Emergency Medicine Performed Compression Ultrasound for the Evaluation of Deep Venous Thrombosis

Accuracy of Emergency Medicine Performed Compression Ultrasound for the Evaluation of Deep Venous Thrombosis

Preoperative duplex ultrasonography evaluation for deep venous thrombosis in revision hip arthroplasty patients.

In a prospective consecutive series, 53 revision hip arthroplasties were performed in 51 patients. Pre- and postoperative Duplex ultrasonography examinations were reviewed by an independent, experienced radiologist. Three of 51 patients (53 procedures) had evidence of chronic deep venous thrombosis (DVT) or other venous abnormality preoperatively, yielding an incidence of 5.6%. One (1.9%) patient developed an acute DVT postoperatively despite pharmacological and mechanical preventative measures. These results indicate the use of preoperative ultrasonography as a screening tool prior to revision hip arthroplasty is not warranted based on the low incidence of acute or chronic DVT detected preoperatively. Long-term anticoagulation, when necessary, can be based on the findings of a postoperative scan.

Computed tomography pulmonary angiography with pelvic venography in the evaluation of thrombo-embolic disease.

A prospective study was performed to evaluate the usefulness of CT pelvic venography (CTV) in the detection of pelvic vein thrombosis in patients referred for CT pulmonary angiography (CTPA) for suspected pulmonary embolism. Fifty consecutive patients referred for CTPA had CTV performed at the time of CTPA. All patients had duplex ultrasound (DUS) of the lower limb veins for evaluation of deep venous thrombosis (DVT) within 24 h of the CT study. Twelve (24%) of the 50 patients had pulmonary embolism diagnosed on CTPA. Associated DVT was detected in six of these patients; two cases were detected by CTV alone, while one case was detected by both CTV and DUS. The remaining three cases had DVT diagnosed by DUS alone. In the 38 patients with a negative CTPA, three patients had venous thrombus diagnosed by CTV. Of these three patients, two had a negative DUS study. CTV therefore led to a definitive imaging diagnosis of thrombo-embolic disease in two (4%) more patients. CTV adds little time and cost to the CTPA examination and leads to a moderate increase in definite imaging diagnosis of thrombo-embolic disease.

1999 plenary session: Friday imaging symposium: role of small-peptide radiopharmaceuticals in the evaluation of deep venous thrombosis.

1999 plenary session: Friday imaging symposium: role of small-peptide radiopharmaceuticals in the evaluation of deep venous thrombosis.

CT-phlebography. A new method for the diagnosis of venous thrombosis of the upper and lower extremities

Spiral CT venography is a new method in vascular imaging, which is an accurate tool for the evaluation of deep venous thrombosis in the evaluation of deep venous thrombosis in the lower and upper extremity. 102 lower extremities and 12 upper extremities were evaluated for deep vein thrombosis using spiral-CT-venography. The results were compared with findings of ascending venography, color coded duplex sonography and clinical follow up. Spiral CT venography of the lower extremity showed a sensitivity of 100% and a specifity of 96%. The quality of venous opacification with CT venography compared with ascending venography was superior in all venous segments. Spiral CT venography is a valuable tool for the detection of deep venous thrombosis. Advantages of the method are the reduction of the amount of contrast material necessary for opacification and the detection of perivascular soft tissue alterations. The application of CT venography is limited due to higher costs and radiation dosage.