Journal of Ultrasound in Medicine, Vol 13, Issue 4 243-250, Copyright © 1994 by American Institute of Ultrasound in Medicine
Distribution of acute lower extremity deep venous thrombosis in symptomatic and asymptomatic patients: imaging implications
S. C. Rose, W. J. Zwiebel and F. J. Miller
Department of Radiology, University of Utah Medical Center, Salt Lake City.
The ability of noninvasive imaging modalities to diagnose lower extremity
DVT depends, in part, on the anatomic location of the thrombus. To define
the pattern of thrombus formation in symptomatic and asymptomatic high-risk
patient populations, 172 consecutive lower extremity venograms were
submitted to blinded, retrospective interpretation. Acute DVT was present
in 59 venograms (34 symptomatic and 25 asymptomatic patients). Among
symptomatic patients with acute DVT, 26 of 34 (76%) patients had an
above-knee thrombus and only eight of 34 (24%) patients had a thrombus
isolated to the calf. In comparison, only three of 25 (12%) asymptomatic
patients with DVT had an above-knee thrombus and 22 of 25 (88%) patients
had a thrombus isolated to the calf veins (most involving only one venous
segment). Failure to examine the calf veins, particularly in asymptomatic
patients, would result in missing at least half of patients with DVT.
Alternatively, since all cases of iliac vein DVT extended into the
femoropopliteal segment, failure to visualize the iliac veins is unlikely
to miss patients with DVT. Our results suggest merit to routine examination
of the deep femoral, anterior tibial, and particularly the soleal (but not
the gastrocnemius) veins and also to use of an imaging technique to detect
congenital duplications of the superficial femoral and popliteal veins.
