Correlation between Bilateral lower Extremity Venous Duplex Ultrasound and CT Pulmonary Angiography in Pulmonary Embolism suspects

Abstract

PURPOSE: Because deep venous thrombosis is clinically linked with pulmonary embolism and often treated similarly, we sought to assess the prevalence of deep venous thrombosis in lower extremity with venous duplex ultrasonography (DUS) in patients who underwent CTPA for evaluation of clinically suspected pulmonary embolism (PE) .

MATERIALS AND METHODS: Three hundred CTPA and duplex US examinations in 300 consecutive patients seen between February 2007 and November 2008 with clinical evidence of PE (117 men and 183 women, aged 16-90 years [mean, 55 years) were prospectively reviewed.

RESULTS: Thrombotic disease was confirmed with DUS in seventy five patients in 300. 36 (16.7%) of 215 patients with normal CTPA and in 39 (45.9%) of 85 patients with abnormal CTPA. In 42(15%) patients without PE spiral CT provided additional information that suggested or confirmed the alternate clinical diagnosis: pleural effusion (n = 20), atelectasis (n =4), air-space consolidation (n =2), mediastinal or hilar lymphadenopathy (n =4),and cardiomegaly (n =12).

CONCLUSION: Spiral CT has good sensitivity and specificity for the diagnosis of PE. In the majority of patients who do not have PE, it also provides important ancillary information for the final diagnosis. Lower extremity DUS as the initial examination in patients suspected of having PE should be used only in those patients who have symptoms or risk factors for DVT. This substantially decrease the number of examinations performed without a decline in DVT detection.