Deep vein thrombosis ultrasound: Difference between revisions
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* Absence of irradiation or contrast material | * Absence of irradiation or contrast material | ||
* High sensitivity and specificity | * High sensitivity and specificity | ||
====Compression Ultrasound in Suspected Recurrent Lower Extremity DVT==== | |||
Shown below are the definitions of negative, positive, and non-diagnostic ultrasound for recurrent DVT.<ref name="pmid22315267">{{cite journal| author=Bates SM, Jaeschke R, Stevens SM, Goodacre S, Wells PS, Stevenson MD et al.| title=Diagnosis of DVT: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. | journal=Chest | year= 2012 | volume= 141 | issue= 2 Suppl | pages= e351S-418S | pmid=22315267 | doi=10.1378/chest.11-2299 | pmc=PMC3278048 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22315267 }} </ref> | |||
* Negative ultrasound: | |||
** Normal US, or | |||
** Increase in residual diameter of less than 2 mm, or | |||
** Area of prior non-compressibility with a decreased or stable residual diameter | |||
* Non-diagnostic US: | |||
** Ultrasound that is technically limited, or | |||
** Area of prior non-compressibility with an increment in residual venous diameter of < 4 mm yet ≥ 2 mm, or | |||
** Area of prior non-compressibility in the absence of a previous measurement of the residual diameter | |||
* Positive US: | |||
** New non-compressible segment, or | |||
** Area of prior non-compressibility with an increment in residual venous diameter of ≥ 4 mm | |||
===Doppler Ultrasound=== | ===Doppler Ultrasound=== | ||
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{{familytree | | | | | E01 | | E02 | E01= Treat DVT| E02= Perform serial US (1st line)<br> OR <br> Treat DVT}} | {{familytree | | | | | E01 | | E02 | E01= Treat DVT| E02= Perform serial US (1st line)<br> OR <br> Treat DVT}} | ||
{{familytree/end}} | {{familytree/end}} | ||
=== Limitations === | === Limitations === | ||
Revision as of 14:42, 16 July 2014
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Resident Survival Guide |
Editor(s)-In-Chief: The APEX Trial Investigators, C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2] ; Kashish Goel, M.D.; Assistant Editor(s)-In-Chief: Justine Cadet
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Deep Vein Thrombosis Microchapters |
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Diagnosis |
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Treatment |
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Deep vein thrombosis ultrasound On the Web |
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Risk calculators and risk factors for Deep vein thrombosis ultrasound |
Overview
Venous ultrasound (US) is the confirmatory test for the diagnosis of deep vein thrombosis (DVT). The US performed for suspected DVT can be either a proximal compression ultrasound (CUS) or a whole-leg US. The most commonly used form is proximal CUS, which assesses the compressibility of femoral and [[popliteal vein]. The diagnosis of DVT is established if the vein can not be collapsed under gentle ultrasound probe pressure. Depending on the results of other tests, a serial CUS might be performed. Whole-leg ultrasound examines the deep veins of the proximal leg and calf; however, it is less commonly used. Iliac vein ultrasound may be performed if thrombosis is suspected in these veins (e.g.: pregnant women with swelling of the whole leg).[1]
Ultrasound
Compression Ultrasonography
Compression ultrasonography in B-mode has high sensitivity and specificity for detecting proximal deep vein thrombosis in symptomatic patients. The sensitivity lies somewhere between 90 to 100% for the diagnosis of symptomatic deep vein thrombosis, and the specificity ranges between 95 to 100%.
- Three months VTE rate with negative ultrasound is 0.57%
- It is one of the diagnostic tests for confirming the disease.
It is currently the first-line imaging examination for DVT because of the following reasons:
- Relative ease of use
- Absence of irradiation or contrast material
- High sensitivity and specificity
Compression Ultrasound in Suspected Recurrent Lower Extremity DVT
Shown below are the definitions of negative, positive, and non-diagnostic ultrasound for recurrent DVT.[1]
- Negative ultrasound:
- Normal US, or
- Increase in residual diameter of less than 2 mm, or
- Area of prior non-compressibility with a decreased or stable residual diameter
- Non-diagnostic US:
- Ultrasound that is technically limited, or
- Area of prior non-compressibility with an increment in residual venous diameter of < 4 mm yet ≥ 2 mm, or
- Area of prior non-compressibility in the absence of a previous measurement of the residual diameter
- Positive US:
- New non-compressible segment, or
- Area of prior non-compressibility with an increment in residual venous diameter of ≥ 4 mm
Doppler Ultrasound
- Doppler US is indicated in suspected upper extremity DVT. Combined US that consists of compression and Doppler or color Doppler should be done.[1]
- Doppler US is also indicated in pregnant women suspected to have isolated iliac vein thrombosis and among whom the proximal CUS revealed no evidence of thrombosis.[1]
Ultrasound Images Demonstrating Upper Extremity Deep Vein Thrombosis
Whole Leg Ultrasound
Whole-leg ultrasound examines the deep veins of the proximal leg and calf; however, it is less commonly used. Shown below is an algorithm that depicts the interpretation of the results of whole leg US.[1]
| Whole leg US | |||||||||||||||||||||||
| Negative | Positive | ||||||||||||||||||||||
| DVT is excluded | Where is the location of the DVT? | ||||||||||||||||||||||
| Proximal DVT | Distal DVT | ||||||||||||||||||||||
| Treat DVT | Perform serial US (1st line) OR Treat DVT | ||||||||||||||||||||||
Limitations
- US has several limitations. As with impedance plethysmography, the results are limited in patients with deformities or a plaster cast.
- Isolated thrombi, present in the following locations, are not identified in:
- Iliac vein
- Femoral vein within the adductor canal
- Serial studies may be needed if the initial test is negative, particularly among patients with moderate or high pretest probability of DVT.
References
- ↑ 1.0 1.1 1.2 1.3 1.4 Bates SM, Jaeschke R, Stevens SM, Goodacre S, Wells PS, Stevenson MD; et al. (2012). "Diagnosis of DVT: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines". Chest. 141 (2 Suppl): e351S–418S. doi:10.1378/chest.11-2299. PMC 3278048. PMID 22315267.