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Doppler Sonographic Assessment of Posttraumatic Reflex Sympathetic Dystrophy

Departments of Radiology (G.P.), Physical Medicine and Rehabilitation (Y.P.), and Nuclear Medicine (A.S.), Trakya University School of Medicine, Edirne, Turkey.

Address correspondence and reprint requests to Gökhan Pekindil, MD, Celal Bayar Universitesi, Tip Fakültesi Radyoloji Anabilim Dali, Manisa, Turkey.

Objective. To reveal the arterial Doppler sonographic findings in cases of posttraumatic reflex sympathetic dystrophy. Methods. Eleven patients had hand reflex sympathetic dystrophy, and 9 had foot reflex sympathetic dystrophy. The duration of symptoms ranged from 1 to 28 weeks, and the history of fracture ranged from 6 to 48 weeks. Bilateral brachial or popliteal arteries proximal to injuries were evaluated by Doppler sonography with a 7.5-MHz linear transducer. All patients also had triphasic bone scintigraphy and extremity thermography. Results. Two patients had monophasic waveforms and 4 had low-pulsatility triphasic waveforms on the affected limbs when compared with the asymptomatic limbs. All opposite asymptomatic limbs had normal triphasic waveforms in these 6 cases. Spectral analysis revealed a loss or decrease of a normal reversed flow component with a reduced pulsatility index on the affected limb. Fourteen other patients had symmetric triphasic waveforms. We observed that the patients who had stage 1 reflex sympathetic dystrophy and warm limbs with durations of symptoms of more than 2 weeks had positive Doppler sonographic findings, whereas all patients with stage 2 reflex sympathetic dystrophy and all with normal skin temperature, regardless of stage, had normal waveforms. Conclusions. Doppler sonography revealed loss of normal triphasic arterial waveforms in some of the cases of stage 1 disease, whereas many cases of stage 1 disease and all cases of stage 2 disease had normal findings. Therefore, we think that Doppler sonography cannot be used for the diagnosis of reflex sympathetic dystrophy but may help in assessing hemodynamic stages of the disease.

Key Words: Doppler sonography • reflex sympathetic dystrophy • vascular sonography

Abbreviations: PI, pulsatility index • RI, resistive index • RSD, reflex sympathetic dystrophy • TPBS, triphasic bone scintigraphy