A Rare Cause of Pulmonary Emboli in a Patient with Deep Vein Thrombosis: Doppler Ultrasonographic Compressibility Maneuver

Bahçivan, Muzaffer; Elmalı, Muzaffer; Karamustafa, Hakan; Aslan, Serdar; Diren, B.

doi:10.1007/s00270-007-9075-9

Cited by 4 publications

(4 citation statements)

References 5 publications

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“…We screened 3,626 articles, 15 of which reported notions about clot dislodgement and embolization following ultrasonographic examination of the extremities. 7,[9][10][11][12][13][14][15][16][17][18][19][20][21][22] Of the 15 potentially relevant articles, 1 was a systematic review that had not found any relevant original reports on the subject, 21 6 articles were narrative reports raising concern about clot embolization with ultrasonographic studies without reporting original cases, 7,10,12,15,18,19 and 8 articles were original reports discussing eight cases who developed probable or confirmed PE following extremity ultrasound (►Fig. 1).…”

Section: Resultsmentioning

confidence: 99%

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Pulmonary Embolism As a Consequence of Ultrasonographic Examination of Extremities for Suspected Venous Thrombosis: A Systematic Review

Mehdipoor

Shabestari

Lip

et al. 2016

Semin Thromb Hemost

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Ultrasonographic examination for deep vein thrombosis (DVT) appears to be a safe diagnostic method, but a theoretical concern has been raised for dislodgment of thrombi during examination. We conducted a systematic review of the literature to identify reports of possible or confirmed pulmonary embolism (PE) as a consequence of ultrasonographic assessment of extremities in patients with suspected DVT. We searched PubMed for studies published in English from January 1, 1960, to April 10, 2015. We included all cohort studies, case series, and case reports that described PE as a consequence of ultrasonographic assessment of extremities. We excluded studies that reported assessment of areas other than extremities. We screened 3,626 articles, 15 of which reported the issue of clot dislodgement and embolization following ultrasonographic examination of the extremities, including 8 original case reports (7 men and 1 woman). DVTs were in the lower extremities in all eight cases: five in right and three in left lower extremity. In six cases, the femoral veins were involved, and a free-floating thrombus was reported in two cases. Compression ultrasonography was used in all cases, with or without adjunct techniques. Overall, there were seven confirmed and one probable PE cases, two of which had fatal outcomes. Clot embolization is a rare but potential complication of ultrasonic examination for DVT that can lead into PE. Radiologists and clinicians should be aware of this potentially serious phenomenon and avoid excessive pressure when performing ultrasonographic studies of the extremities.

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Section: Resultsmentioning

confidence: 99%

“…1). 9,11,13,14,16,17,20,22 Despite our highly sensitive search, we did not find any prospective or retrospective registries that had addressed the issue of clot dislodgement and embolization following ultrasonography.…”

Section: Resultsmentioning

confidence: 99%

Pulmonary Embolism As a Consequence of Ultrasonographic Examination of Extremities for Suspected Venous Thrombosis: A Systematic Review

Mehdipoor

Shabestari

Lip

et al. 2016

Semin Thromb Hemost

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“…6 This may encourage the operator to begin their evaluation with DCI and/or spectral Doppler assessment of filling within the venous lumen by distal augmentation (usually calf compression or squeeze), which is less painful than direct compression of the treated area with the transducer. By doing so, a theoretical concern exists, but without clear evidence, of dislodging acute thrombus within the deep system which may then embolize causing pulmonary embolism 7 and potential death. This is also relevant in context to the reported endovenous heat-induced thrombosis (EHIT), where a ‘tongue’ of thrombus extending from the superficial into the deep venous system proximal to a site of thermoablation 8 may easily break off and embolize by the augmented deep venous blood flow.…”

Section: Discussionmentioning

confidence: 99%

Technical tip: duplex surveillance for deep vein thrombosis post endoluminal venous procedures

et al. 2011

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Duplex ultrasound imaging of the venous system has become the procedure of choice to evaluate the technical success post endoluminal ablative procedures and in the diagnosis of proximal leg DVT, which may occur as a rare complication. The purpose of this technical tip is to highlight the information that could be gathered by stepwise assessment of the deep venous system including the junctions with simple B-mode and Doppler colour flow imaging for the presence of an acute thrombus. This technique in turn may obviate the need for distal augmentation manoeuvres that is often used to demonstrate filling within the venous lumen and hence preclude potential iatrogenic thrombo-embolism.

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“…Although this is the case in the majority, there are some very well-recognised pitfalls that can result in reassuringly false negative scans and this particular manoeuvre, despite being helpful on a number of occasions, should not be relied upon in isolation to confirm or refute a diagnosis of DVT. In addition, augmentation should be performed in a controlled manner, given the potential risk of dislodging thrombus and a resultant pulmonary embolus 29,30 (see 'Problems and pitfalls').…”

Section: Distal Augmentationmentioning

confidence: 99%

Peripheral veins

Baxter¹,

Goss²

2011

Clinical Ultrasound

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A Rare Cause of Pulmonary Emboli in a Patient with Deep Vein Thrombosis: Doppler Ultrasonographic Compressibility Maneuver

Cited by 4 publications

References 5 publications

Pulmonary Embolism As a Consequence of Ultrasonographic Examination of Extremities for Suspected Venous Thrombosis: A Systematic Review

Pulmonary Embolism As a Consequence of Ultrasonographic Examination of Extremities for Suspected Venous Thrombosis: A Systematic Review

Technical tip: duplex surveillance for deep vein thrombosis post endoluminal venous procedures

Peripheral veins

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