Deep Venous Thrombosis Ultrasound Evaluation

Excerpt

Deep venous thrombosis (DVT) is a common condition that appears in the emergency department and outpatient settings. Clinical diagnosis is unreliable due to the infrequency of the classic findings of edema, warmth, erythema, pain, and tenderness, which are present only in 23% to 50% of patients. When a patient presents with findings consistent with DVT, it is important to make an accurate diagnosis, as the risk of failing to treat the condition involves pulmonary embolism (PE), superior vena cava syndrome (SVCS), and associated complications including death. However, empiric treatment with anticoagulation also comes with a high risk and cost to the patient. Venogram remains the "gold standard" for diagnosis of DVT. However, ultrasound is the most accurate non-invasive test to diagnose DVT. There are two main ways that ultrasound can be used to diagnose a DVT. The classic method is elective ultrasound performed by trained ultrasound technologist and read by radiology. Recently, a few studies have demonstrated that well-trained emergency and critical care physicians can complete bedside ultrasonography for lower extremity DVT with sensitivities and specificities of 95% and 96%, respectively. If this is possible, this would significantly be able to improve emergency department throughput times for the most common type of DVT. Two-point compression has been widely accepted as a rapid way to assess for DVT in patients with a low pretest probability, making this an even more rapid way to assess for DVT than the complete assessment at the bedside.