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Lower-Extremity Ultrasound as an Initial Test for PE?

For patients with suspected pulmonary embolism (PE), one proposed strategy is to use lower-extremity ultrasound as the initial diagnostic test: A finding of deep venous thrombosis (DVT) would obviate the need to test further for PE. Harvard researchers examined the yield of lower-extremity ultrasound as the initial test in a prospective study of 182 patients with suspected PE. For each patient, risk factors (i.e., malignancy, hypercoagulable state, prior DVT, pregnancy, immobility, recent surgery), as well as symptoms and signs of DVT, were recorded.

Of the 182 patients, 89 had neither symptoms/signs nor risk factors for DVT; none had DVT on ultrasound. In contrast, the prevalence of ultrasound-detected DVT was 25 percent among the 12 patients with risk factors and symptoms/signs, 14 percent among the 43 patients with risk factors only, and 24 percent among the 38 patients with symptoms/signs only.

Comment: This study suggests that lower-extremity ultrasound should not be the initial test in patients with suspected PE who have no risk factors and no symptoms or signs of DVT. The ultrasound is highly likely to be negative in this setting, yet previous research has shown that a small but finite number of such patients in fact will have PE.

— AS Brett

Published in Journal Watch General Medicine July 23, 1999

Citation(s):

Sheiman RG and McArdle CR. Clinically suspected pulmonary embolism: Use of bilateral lower extremity US as the initial examination -- a prospective study. Radiology 1999 Jul 212 75-78.

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