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Ultrasonography of Leg Veins in Patients Suspected of Having Pulmonary Embolism
- John G. Weg, MD; and
- James B. Froehlich, MD
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TO THE EDITOR:
Turkstra and colleagues espouse an untenable position: that a positive result on ultrasonography for deep venous thrombosis of the thigh is false if pulmonary embolism is not documented and that asymptomatic deep venous thrombosis therefore need not be treated in the absence of pulmonary embolism. Untreated symptomatic deep venous thrombosis has a historical mortality rate of 12% to 37% [1]; in asymptomatic, high-risk patients, the mortality rate is 1% to 5% [2]. Although the handful of patients not treated in this study did not develop pulmonary embolism or die, the standard of care mandates anti-coagulation for deep venous thrombosis of the lower extremity, including the calf [3]. Although ultrasonography is less sensitive below the knee, it can identify deep venous thrombosis of a calf vein [4]. Imaging below the knee is an essential component of ultrasonography of the lower extremity.
The authors confirm well-known data: 1) Forty percent to 60% or more of patients with pulmonary embolism have negative results on noninvasive studies for deep venous thrombosis [4]; 2) results of such studies are negative in 40% to 70% of high-risk patients without signs or symptoms of deep venous thrombosis compared with venography [4]; and 3) 50% to 65% of patients with proven deep venous thrombosis have asymptomatic pulmonary embolism [5]. Because deep venous thrombosis and pulmonary medicine represent the continuum of venous thromboembolic disease, a positive result on noninvasive testing has been established as a surrogate for pulmonary embolism and the justification for its treatment. The sensitivity and specificity of ultrasonography is a measure of the method's ability to detect deep venous thrombosis and is appropriately evaluated by venography of the lower extremity. Turkstra and colleagues described the correlation between ultrasonographically documented deep venous thrombosis and pulmonary embolism in patients suspected of having pulmonary embolism; they did not describe the sensitivity and specificity of lower-extremity ultrasonography.
Treatment of deep venous thrombosis reduces the incidence of recurrent deep venous thrombosis, the postphlebitic syndrome, pulmonary embolism, and death from venous thromboembolism. A person with a positive result on a noninvasive study of the legs must receive anticoagulation [3].
John G. Weg, MD
James B. Froehlich, MD
University of Michigan Medical Center; Ann Arbor, MI 48109
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
