Deep vein thrombosis ultrasound

Jump to navigation Jump to search


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

Deep Vein Thrombosis Microchapters

Home

Patient Information

Overview

Classification

Pathophysiology

Causes

Differentiating Deep vein thrombosis from other Diseases

Epidemiology and Demographics

Risk Factors

Triggers

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Approach

Assessment of Clinical Probability and Risk Scores

Assessment of Probability of Subsequent VTE and Risk Scores

History and Symptoms

Physical Examination

Laboratory Findings

Ultrasound

Venography

CT

MRI

Other Imaging Findings

Treatment

Treatment Approach

Medical Therapy

IVC Filter

Invasive Therapy

Surgery

Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Special Scenario

Upper extremity DVT

Recurrence

Pregnancy

Trials

Landmark Trials

Case Studies

Case #1

Deep vein thrombosis ultrasound On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Deep vein thrombosis ultrasound

CDC on Deep vein thrombosis ultrasound

Deep vein thrombosis ultrasound in the news

Blogs on Deep vein thrombosis ultrasound

Directions to Hospitals Treating Deep vein thrombosis

Risk calculators and risk factors for Deep vein thrombosis ultrasound

Overview

Venous ultrasound (US) is 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 veins. 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).

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%.

Sensitivity
  • Three months VTE rate with negative ultrasound is 0.57%
Specificity
  • 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

Ultrasound Images Demonstrating Upper Extremity Deep Vein Thrombosis





Ultrasound in Suspected Recurrent Lower Extremity DVT

Shown below are the definitions of negative, positive, and non-diagnostic ultrasound for recurrent DVT.

  • 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[1]

Limitations

It has several limitations.

References

  1. 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.

Template:WH Template:WS