Abstract
Background: Venous thromboembolism is a disorder including both deep venous thrombosis, the most common form of venous thromboembolism and pulmonary thromboembolism which is the most life-threatening manifestation of venous thromboembolism. The imaging evaluation of the venous thromboembolism ideally should include both deep veins of lower limbs and pulmonary arterial system1.Recent advances in the imaging techniques have made possible to evaluate the spectrum of imaging findings in venous thromboembolism, the most common and the evolving one being CT pulmonary angiography with indirect venography.
Objectives: 1.To calculate the proportion of patients having DVT as diagnosed using indirect venography in clinically suspected cases of pulmonary embolism. 2.To determine the proportion of patients with venous thromboembolism, i.e., concomitant DVT and PE, DVT alone and pulmonary embolism alone.
Materials and Methods: Patients who were clinically suspected to have pulmonary embolism underwent CT pulmonary angiography along with indirect venography. Clinical symptoms, signs and echo findings of these patients were collected using pre-prepared proforma, and the prevalence was calculated. Also, the prevalence of venous thromboembolism (combined pulmonary embolism and deep venous thrombosis), pulmonary embolism alone and deep venous thrombosis alone were evaluated using with SPSS, version 22.
Results: The study population comprised of 66 patients; The prevalence of venous thromboembolism in our study population was 37.87%, i.e., 25 patients with venous thromboembolism out of 66 suspected cases of pulmonary embolism. Prevalence of pulmonary embolism was 19(28.78%), and deep venous thrombosis was 19(28.78%). Out of the 25 patients with venous thromboembolism, 13 (19.7% of all patients and 52% of patients with venous thromboembolism) had both pulmonary embolism and deep venous thrombosis. Isolated pulmonary embolism and isolated deep venous thrombosis was seen in 6 (9.09% of all patients and 24% of patients with venous thromboembolism) patients each.
Conclusion: We conclude that, the proportion of patients with venous thromboembolism was 37.8 %; with concomitant PE and DVT in 19.7 % patients, isolated DVT and isolated PE each in 9.0 % patients. Our study also showed that there was isolated occurrence of pulmonary embolism and isolated deep venous thrombosis which emphasizes the need to screen for DVT during the evaluation of any suspected cases of pulmonary embolism.
Keywords: VTE: Venous thromboembolism, DVT: Deep venous thrombosis, PE: Pulmonary embolism, CT: Computed Tomography.
References
- Merli G. Diagnostic assessment of deep vein thrombosis and pulmonary embolism. Am J Med 2005; 118[suppl 8A]:3S–12S.
- Inter societal Accreditation Commission. ICAVL: Essentials and standards for accreditation in noninvasive vascular testing. Part II. Vascular laboratory operations – Peripheral venous testing. ; 2000: 1–8.
- Fraser JD, Anderson DR. Deep venous thrombosis: recent advances and optimal investigation with US. Radiology 1999; 211:9–24. intersocietal.org/intersocietal.htm.
- Kohli, D Rajput, M Gomes, S Desai. Review article: Imaging of pulmonary thromboembolism. Ind J Radiol Img 2002; Volume 12: 207-212.
- Monreal M, Barba R, Tolosa C, Tiberio G, Todolí J, Samperiz AL. RIETE Investigators Deep vein thrombosis and pulmonary embolism: the same disease? Pathophysiol Haemost Thromb. 2006;35:133–135. doi: 10.1159/000093555. [PubMed] [Cross Ref].
- Bauer AR Jr, Flynn RR. Computed tomography diagnosis of venous thrombosis of the lower extremities and pelvis with contrast material. Surg Gynecol Obstet 1988; 167:12–15.
- Tarbox AK, Swaroop M. Pulmonary embolism. Int J Crit Illn Inj Sci. 2013Jan;3(1):69-72. doi: 10.4103/2229-5151.109427. PubMed PMID: 23724389; PubMedCentral PMCID: PMC3665123.
- Riedel M. Acute pulmonary embolism 1: pathophysiology, clinical presentation, and diagnosis. Heart. 2001 Feb;85(2):229-40. Review. PubMed PMID: 11156681;PubMed Central PMCID: PMC1729607.
- Tovey C, Wyatt S. Diagnosis, investigation, and management of deep vein thrombosis. BMJ 2003;326:1180-4.
- Goodacre S, Sampson F, Thomas S, van BE, Sutton A. Systematic review and meta-analysis of the diagnostic accuracy of ultrasonography for deep vein thrombosis. BMC Med Imaging 2005; 5: 6.
- Mos IC, Klok FA, Kroft LJ, DE RA, Dekkers OM, Huisman MV. Safety of ruling out acute pulmonary embolism by normal computed tomography pulmonary angiography in patients with an indication for computed tomography: systematic review and meta-analysis. J Thromb Haemost 2009;
- Mavili E, Ozturk M, Akcali Y, Donmez H, Yikilmaz A, Tokmak TT, Ozcan N. Direct CT venography for evaluation of the lower extremity venous anomalies of Klippel-Trenaunay Syndrome. AJR Am J Roentgenol. 2009 Jun;192(6):W311-6. doi: 10.2214/AJR.08.1151. PubMed PMID: 19457795 1491-8
- Cham MD1, Yankelevitz DF, Shaham D, Shah AA, Sherman L, Lewis A, Rademaker J, Pearson G, Choi J, Wolff W, Prabhu PM, Galanski M, Clark RA, Sostman HD, Henschke CI. Deep venous thrombosis: detection by using indirect CT venography. The Pulmonary Angiography-Indirect CT Venography Cooperative Group. 2000 Sep;216(3):744-51.
- Karande GY, Hedgire SS, Sanchez Y, Baliyan V, Mishra V, Ganguli S, Prabhakar AM. Advanced imaging in acute and chronic deep vein thrombosis. Cardiovasc Diagn Ther. 2016 Dec;6(6):493-507. doi: 10.21037/cdt.2016.12.06.
- Nazaroğlu H, Ozmen CA, Akay HO, Kilinç I, Bilici A. 64-MDCT pulmonaryangiography and CT venography in the diagnosis of thromboembolic disease. AJR Am J Roentgenol. 2009 Mar;192(3): 654-61. doi: 10.2214/AJR.07.3939. PubMed PMID:19234261.
- Shi WY, Wang LW, Wang SJ, Yin XD, Gu JP. Combined Direct and Indirect CT Venography (Combined CTV) in Detecting Lower Extremity Deep Vein Thrombosis. Medicine (Baltimore). 2016 Mar;95 (11): e3010. doi: 10.1097/MD.0000000000003010. PubMed PMID: 26986113; PubMed Central PMCID: PMC4839894.
Corresponding Author
Dr Mathew George
Assistant Professor, Pushpagiri Institute of Medical Sciences & Research Centre, Thiruvalla, Kerala, India
DOI: https://dx.doi.org/10.18535/jmscr/v7i12.97
