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Ultrasound Spots Upper Extremity Deep Venous Thrombosis
A DGReview of :"Prospective Study of Color Duplex Ultrasonography Compared with Contrast Venography in Patients Suspected of Having Deep Venous Thrombosis of the Upper Extremities"
Annals of Internal Medicine
06/28/2002
By Anne MacLennan
Duplex ultrasonography may be the best approach for making an initial diagnosis of suspected thrombosis of the upper extremities while contrast venography should be done in people with isolated flow abnormalities.
These are among findings of a study from the Academic Medical Center, Amsterdam, the Netherlands and Royal Hallamshire Hospital, Sheffield, England.
Until now, the optimal strategy for diagnosing deep venous thrombosis (DVT) has not been as well established for upper as for lower extremities.
Duplex colour sonography can be difficult to do in the upper extremities because of their anatomy, and contrast venography is often indicated. Moreover, data have been limited on use of the technique in these patients.
To determine the accuracy of duplex ultrasonography, Dr Henk-Jan Baarslag and colleagues prospectively compared ultrasonography with contrast venography in 126 consecutive hospital inpatients and outpatients with suspected DVT of the upper extremities.
The researchers obtained contrast venography after duplex ultrasonography and then used a three-step protocol involving compression ultrasonography, color ultrasonography and color Doppler ultrasonography.
Sensitivity, specificity and likelihood ratios for ultrasonography as a whole were calculated and the independent value of each step assessed.
Overall, venography and ultrasonography were not feasible in 23 of 126 patients (18 percent) and one of 126 patients (0.8 percent), respectively. In three patients, results of ultrasonography were inconclusive.
Venography showed thrombosis in 44 of 99 patients (44 percent); in 36 patients (36 percent), thrombosis was related to intravenous catheters or malignant disease.
Both sensitivity and specificity of duplex ultrasonography were 82 percent.
Although venous incompressibility correlated well with thrombosis, only 50 percent of isolated flow abnormalities proved to be thrombosis-related.
Ann Intern Med. 2002;136:865-872.
"Prospective Study of Color Duplex Ultrasonography Compared with Contrast Venography in Patients Suspected of Having Deep Venous Thrombosis of the Upper Extremities"
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