Deep vein thrombosis ultrasound
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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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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
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 | ||||||||||||||||||||||
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
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.