Seminars in Nuclear Medicine
Volume 38, Issue 6 , Pages 412-417 , November 2008

The Use of Leg Venous Ultrasonography for the Diagnosis of Pulmonary Embolism

  • David R. Anderson, MD, FRCP(C)

      Affiliations

    • Departments of Medicine, Pathology and Community Health and Epidemiology, Dalhousie University and Capital Health, Halifax, Nova Scotia, Canada
    • Corresponding Author InformationAddress reprint requests to David R. Anderson, MD, FRCP(C), Department of Medicine, Dalhousie University, 1278 Tower Road, Room 430, Bethune Building, VG Site, Halifax, NS B3H 2Y9, Canada
  • ,
  • David Barnes, MD, FRCP(C)

      Affiliations

    • Department of Radiology, Dalhousie University and Capital Health, Halifax, Nova Scotia, Canada

References 

  1. Goldhaber SZ. Pulmonary embolism. Lancet. 2004;363:1295–1305
  2. Goldhaber SZ, Visani L, De Rosa M. Acute pulmonary embolism: Clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER). Lancet. 1999;353:1386–1389
  3. Kearon C, Julian JA, Newman TE, Ginsberg JS. Noninvasive diagnosis of deep venous thrombosis (McMaster Diagnostic Imaging Practice Guidelines Initiative). Ann Intern Med. 1998;128:663–677
  4. Lensing AW, Prandoni P, Brandjes D, et al. Detection of deep-vein thrombosis by real-time B-mode ultrasonography. N Engl J Med. 1989;320:342–345
  5. Quintavalla R, Larina P, Miselli A, et al. Duplex ultrasound diagnosis of symptomatic proximal deep vein thrombosis of lower limbs. Eur J Radiol. 1992;15:32–36
  6. Cogo A, Lensing AW, Prandoni P, et al. Distribution of thrombosis in patients with symptomatic deep vein thrombosis (Implications for simplifying the diagnostic process with compression ultrasound). Arch Intern Med. 1993;153:2777–2780
  7. Moser K, LeMoine J. Is embolic risk conditioned by location of deep venous thrombosis?. Ann Intern Med. 1981;94:439–444
  8. Kakkar VV, Flanc C, Howe CT, et al. Natural history of postoperative deep vein thrombosis. Lancet. 1969;2:230–232
  9. Stevens SM, Elliott CG, Chan KJ, et al. Withholding anticoagulation after a negative result on duplex ultrasonography for suspected symptomatic deep venous thrombosis. Ann Intern Med. 2004;140:985–992
  10. Girard G, Decousus M, Laporte S, et al. Diagnosis of pulmonary embolism in patients with proximal deep vein thrombosis: Specificity of symptoms and perfusion defects at baseline and during anticoagulant therapy. Am J Respir Crit Care Med. 2001;164:1033–1037
  11. Huisman MV, Buller HR, ten Cate JW, et al. Unexpected high prevalence of silent pulmonary embolism in patients with deep venous thrombosis. Chest. 1989;95:498–502
  12. Kovacs MJ, Kahn SR, Rodger M, et al. A pilot study of central venous catheter survival in cancer patients using low-molecular-weight heparin (dalteparin) and warfarin without catheter removal for the treatment of upper extremity deep vein thrombosis (The Catheter Study). J Thromb Haemost. 2007;5:1650–1653
  13. Couban S, Goodyear M, Burnell , et al. Randomized placebo-controlled study of low-dose warfarin for the prevention of central venous catheter-associated thrombosis in patients with cancer. J Clin Oncol. 2005;23:4063–4069
  14. Stern J-B, Abehsera M, Grenet D, et al. Detection of pelvic vein thrombosis by magnetic resonance angiography in patients with acute pulmonary embolism and normal lower limb compression ultrasonography. Chest. 2002;122:115–121
  15. Sevitt S, Gallagher N. Venous thrombosis and pulmonary embolism: A clinico-pathological study in injured and burned patients. Br J Surg. 1961;48:475–489
  16. Havig GO. Source of pulmonary emboli. Acta Chir Scand. 1977;478(suppl):42–47
  17. McLaughlin AD, Paterson J. Some basic observations on venous thrombosis and pulmonary embolism. Surg Gynecol Obstet. 1951;93:1–7
  18. Kruit W, De Boer A, Sking A, et al. The significance of venography in the management of patients with clinically suspected pulmonary embolism. J Intern Med. 1991;230:333–339
  19. Girard P, Musset D, Parent F, et al. High prevalence of detectable deep venous thrombosis in patients with acute pulmonary embolism. Chest. 1999;116:903–908
  20. Hull RD, Hirsh J, Carter CJ, et al. Pulmonary angiography, ventilation lung scanning, and venography for clinically suspected pulmonary embolism with abnormal perfusion lung scan. Ann Intern Med. 1983;98:891–899
  21. Van Rossum AB, Van Houwelingen HC, Kieft GJ, et al. Prevalence of deep vein thrombosis in suspected and proven pulmonary embolism: A meta-analysis. Br J Radiol. 1998;71:1260–1265
  22. MacGillavry MR, Sanson BJ, Buller HR, et al. Compression ultrasonography of the leg veins in patients with clinically suspected pulmonary embolism. Thromb Haemost. 2000;84:973–976
  23. Turkstra F, Kuijer PMM, van Beek EJR, et al. Diagnostic utility of ultrasonography of leg veins in patients suspected of having pulmonary embolism. Ann Intern Med. 1997;126:775–781
  24. Matteson B, Langsfeld M, Schermer C, et al. Role of venous duplex scanning in patients with suspected pulmonary embolism. J Vasc Surg. 1996;24:768–773
  25. Perrier A, Bounameaux H, Morabia A, de Moerloose P, et al. Diagnosis of pulmonary embolism by a decision analysis-based strategy including clinical probability, D-dimer levels, and ultrasonography: A management study. Arch Intern Med. 1996;156:531–536
  26. Kearon C, Ginsberg J, Hirsch J. The role of venous ultrasonography in the diagnoses of suspected deep venous thrombosis and pulmonary embolism. Ann Intern Med. 1998;129:1044–1049
  27. Elias A, Colombier D, Victor G, et al. Diagnostic performance of complete lower limb venous ultrasound in patients with clinically suspected acute pulmonary embolism. Thromb Haemost. 2004;91:187–195
  28. Fraser JD, Anderson DR. Deep venous thrombosis: Recent advances and optimal investigation with US. Radiology. 1999;211:9–24
  29. Eze AR, Comerota AJ, Kerr RP, et al. Is venous duplex imaging an appropriate initial screening test for patients with suspected pulmonary embolism?. Ann Vasc Surg. 1996;10:220–223
  30. Emmerich J. Looking for deep vein thrombosis in suspected pulmonary embolism. Semin Vasc Med. 2001;1:181–187
  31. Sheiman RG, McArdle CR. Clinically suspected pulmonary embolism: Use of bilateral lower extremity US as the initial examination—a prospective study. Radiology. 1999;212:75–78
  32. Anderson DR, Kahn SR, Rodger MA, et al. Computed tomographic pulmonary angiography vs ventilation-perfusion lung scanning in patients with suspected pulmonary embolism: A randomized controlled trial. JAMA. 2007;298:2744–2753
  33. Righini M, LeGal G, Aujesky D, et al. Diagnosis of pulmonary embolism by multi-detector CT alone or combined with venous ultrasonography of the leg: A randomized non-inferiority trial. Lancet. 2008;371:1343–1352
  34. Girard P, Sanchez O, Leroyer C, et al. Deep venous thrombosis in patients with acute pulmonary embolism: Prevalence, risk factors and clinical significance. Chest. 2005;128:1593–1600
  35. Birdwell BG, Raskob GE, Whitsett TL, et al. The clinical validity of normal compression ultrasonography in outpatients suspected of having deep venous thrombosis. Ann Intern Med. 1998;128:1–7
  36. Cogo A, Lensing AW, Koopman MM, et al. Compression ultrasonography for diagnostic management of patients with clinically suspected deep vein thrombosis: Prospective cohort study. BMJ. 1998;316:17–20
  37. The PIOPED Investigators. Value of the ventilation/perfusion scan in acute pulmonary embolism: Results of the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED). JAMA. 1990;263:2753–2759
  38. Wells PS, Anderson DR, Rodger M, et al. Excluding pulmonary embolism at the bedside without diagnostic imaging: Management of patients with suspected pulmonary embolism presenting to the emergency department by using a simple clinical model and D-dimer. Ann Intern Med. 2001;135:98–107
  39. Stein PD, Hull RD, Raskob GE. Withholding treatment in patients with acute pulmonary embolism who have a high risk of bleeding and negative serial noninvasive leg tests. Am J Med. 2000;109:301–306
  40. Stein PD, Hull RD, Pineo G. Strategy that includes serial noninvasive leg tests for diagnosis of thromboembolic disease in patients with suspected acute pulmonary embolism based on data from PIOPED. Arch Intern Med. 1995;155:2101–2104
  41. Wells PS, Anderson DR, Bormanis J, et al. Value of assessment of pretest probability of deep-vein thrombosis in clinical management. Lancet. 1997;350:1795–1798
  42. Wells PS, Anderson DR, Rodger M, et al. Evaluation of D-dimer in the diagnosis of suspected deep-vein thrombosis. N Engl J Med. 2003;349:1227–1235
  43. Perrier A, Desmarais S, Miron MJ, et al. Non-invasive diagnosis of venous thromboembolism in outpatients. Lancet. 1999;353:190–195
  44. Kruip MJHA, Slob MJ, Schijen JEM, et al. Use of clinical decision rule in combination with D-dimer concentration in diagnostic workup of patients with suspected embolism: A prospective management study. Arch Intern Med. 2002;162:631–1635
  45. Roy P-M, Colombet I, Durieux P, et al. Systematic review and meta-analysis of strategies for the diagnoses of suspected pulmonary embolism. BMJ. 2005;157:295–299
  46. Kruip M, Leclercq M, van der Heul C, et al. Diagnostic strategies for excluding pulmonary embolism in clinical outcome studies. Ann Intern Med. 2003;138:941–951
  47. Wells PS, Anderson DR, Rodger M, et al. Excluding pulmonary embolism at the bedside without diagnostic imaging: Management of patients with suspected pulmonary embolism presenting to the emergency department by using a simple clinical model and D-dimer. Ann Intern Med. 2001;135:98–107
  48. Ten Wolde M, Hagen PJ, MacGillavry MR, et al. Non-invasive diagnostic work-up of patients with clinically suspected pulmonary embolism; results of a management study. J Thromb Haemost. 2004;2:1110–1117
  49. Stein PD, Athanasoulis C, Alavi A, et al. Complications and validity of pulmonary angiography in acute pulmonary embolism. Circulation. 1992;85:462–468
  50. Stein P, Hull R. Multidetector computed tomography for the diagnosis of acute pulmonary embolism. Curr Opin Pulm Med. 2007;13:384–388
  51. Rathbun SW, Raskob GE, Whitsett TL. Sensitivity and specificity of helical computed tomography in the diagnosis of pulmonary embolism: A systematic review. Ann Intern Med. 2000;132:227–232
  52. Mullins MD, Becker DM, Hagspiel KD, et al. The role of spiral volumetric computed tomography in the diagnosis of pulmonary embolism. Arch Intern Med. 2000;160:293–298
  53. Stein P, Fowler S, Goodman L, et al. Multidetector computed tomography for acute pulmonary embolism. N Eng J Med. 2006;354:2317–2327
  54. van Strijen M, de Monye W, Schiereck J, et al. Single-detector helical computed tomography as the primary diagnostic test in suspected pulmonary embolism: A multicenter clinical management of 510 patients. Ann Intern Med. 2003;138:307–314
  55. Musset D, Parent F, Meyer G, et al. Diagnostic strategy for patients with suspected pulmonary embolism: A prospective multicentre outcome study. Lancet. 2002;360:1914–1920
  56. Anderson DR, Kovacs MJ, Dennie C, et al. Use of spiral computed tomography contrast angiography and ultrasonography to exclude the diagnosis of pulmonary embolism in the emergency department. J Emerg Med. 2005;29:399–404
  57. Perrier A, Roy PM, Aujesky D. Diagnosing pulmonary embolism in outpatients with clinical assessment, D-dimer measurement, venous ultrasound, and helical computed tomography: A multicenter management study. Am J Med. 2004;116:291–299
  58. Ghanima W, Almaas V, Aballi S, et al. Management of suspected pulmonary embolism (PE) by D-dimer and multi-slice computed tomography in outpatients: An outcome study. J Thromb Haemost. 2005;3:1926–1932
  59. Halkes C, Heggelman B, Nix M. Effectiveness of managing suspected pulmonary embolism using an algorithm combining clinical probability, D-dimer testing, and computed tomography. JAMA. 2006;295:172–179
  60. Nchimi A, Ghaye B, Noukoua C, et al. Incidence and distribution of lower extremity deep venous thrombosis at indirect computed tomography venography in patients suspected of pulmonary embolism. Thromb Hasemost. 2007;97:566–572
  61. Cham M, Yankelevitz D, Henschke C. Thromboembolic disease detection at indirect CT venography versus CT pulmonary angiography. Radiology. 2005;234:591–594
  62. Cham M, Yankelevitz D, Shaham D, et al. Deep venous thrombosis: Detection by using indirect CT venography. Radiology. 2000;216:744–751
  63. Begemann P, Bonacker M, Kemper J, et al. Evaluation of the deep venous system in patients with suspected pulmonary embolism with multi-detector CT: A prospective study in comparison to Doppler sonography. J Comp Assist Tomogr. 2007;27:399–409
  64. Grebe M. Combined computed tomographic (CT)-angiography and indirect CT-venography for the diagnosis of pulmonary embolism: Is more scanning better?. Thromb Haemost. 2007;97:501–502

PII: S0001-2998(08)00096-2

doi: 10.1053/j.semnuclmed.2008.07.003

Seminars in Nuclear Medicine
Volume 38, Issue 6 , Pages 412-417 , November 2008