It's Not All Deep Vein Thrombosis: Sonography of the Painful Lower Extremity With Multimodality Correlation

Naringrekar, Haresh; Sun, Joel Y.; Ko, Charles; Rodgers, Shuchi K.

doi:10.1002/jum.14776

Cited by 15 publications

(5 citation statements)

References 18 publications

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“…The ultrasonographic appearance of an acute thrombus has been reported to be hypoechoic or anechoic. 17,18 The absence of color flow in color Doppler of the CFA confirmed this hypothesis in our patient. Acute compartment syndrome after a crocodile bite has been reported, leading to vascular compression and presenting with features of acute limb ischemia.…”

Section: Discussionsupporting

confidence: 87%

A Rare Case of Limb-Threatening Injury Secondary to Extrinsic Vascular Compression Following Crocodile Bite

Aswin

Ayyan²,

Ezhilkugan³

et al. 2022

Wilderness & Environmental Medicine

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Crocodile bites lead to fatal and nonfatal outcomes in humans. Mugger crocodiles (Crocodylus palustris) and saltwater crocodiles (Crocodylus porosus) are common in India. Most crocodile bites can cause severe injuries, especially to the extremities, due to the substantial bite force of the crocodile, which typically leads to extensive tissue damage, fractures, amputations, and vascular injuries. We report the case of a crocodile bite victim who presented with features of acute limb ischemia, was found to have vascular thrombosis of the common femoral artery, and was experiencing complete compression of the femoral vein due to external vascular compression by a hematoma. We discuss various injury mechanisms sustained in crocodile bites and the roles of point-of-care ultrasound and continuous tomography angiography, which could help identify these injuries. After thrombectomy and hematoma evacuation the patient recovered and was discharged without any physical dysfunction.

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Section: Discussionsupporting

confidence: 87%

A Rare Case of Limb-Threatening Injury Secondary to Extrinsic Vascular Compression Following Crocodile Bite

Aswin

Ayyan²,

Ezhilkugan³

et al. 2022

Wilderness & Environmental Medicine

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“…We prefer to perform a whole-leg ultrasound in all patients with suspected acute DVT in our institution, conforming to current multidisciplinary guidelines [4]. The major advantage of this approach, in addition to detection of isolated calf DVT, is that it allows to identify alternative diagnoses which may have caused the patient's leg symptoms, thereby mimicking acute DVT [9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Prevalence and predictors of alternative diagnoses on whole-leg ultrasound negative for acute deep venous thrombosis

et al. 2020

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Background To investigate the prevalence, spectrum, and predictors of alternative diagnoses explaining leg symptoms in patients negative for suspected acute deep venous thrombosis (DVT), which can be detected with whole-leg ultrasound. Methods We retrospectively analyzed a cohort of 789 patients (median age 70 years, 50.6% women) evaluated with a whole-leg ultrasound examination for suspected acute DVT within one year. All findings in the radiology report were analyzed and electronic chart review was performed to collect clinical information. Results Ultrasound was negative for acute DVT in 531 patients (67.3%). Among these, alternative diagnoses explaining leg symptoms were seen in 349 patients (65.7%). The most frequent alternative diagnoses were chronic venous insufficiency (147 patients, 27.7%), followed by lymphedema (48 patients, 9.0%) and chronic post-thrombotic changes (41 patients, 7.7%). Patients with alternative diagnoses were older (median 71 vs. 66 years, p = 0.0226), as well as more likely to present with leg swelling (39.5% vs. 23.1%, p = 0.0002), difference in leg circumference (25.5% vs. 14.8%, p = 0.0055) and redness (7.7% vs. 2.7%, p = 0.0213) than patients without alternative diagnosis. Independent predictors of finding alternative diagnoses on whole-leg ultrasound were older age (odds ratio 1.014 per year, p = 0.0119), leg swelling (OR 1.949, p = 0.0020) and history of previous DVT (OR 2.235, p = 0.0154). Conclusions Alternative diagnoses explaining leg symptoms can be detected on whole-leg ultrasound in two thirds of patients with no evidence of acute DVT. Our data supports performing a comprehensive ultrasound evaluation beyond the venous system, particularly, in older patients, who present with leg swelling and a past history of DVT.

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“…There are several potential causes of a false positive POCUS evaluation for DVT worth noting. Superficial thrombophlebitis can be mistaken for DVT, however the major difference is that superficial veins do not accompany arteries while deep veins do [55]. A Baker's cyst appears as a circular anechoic structure in the popliteal fossa that can resemble a non-compressible vein (Supplemental Video S9) [56].…”

Section: Limitationsmentioning

confidence: 99%

The Use of Point-of-Care Ultrasound (POCUS) in the Diagnosis of Deep Vein Thrombosis

Varrias

Palaiodimos

Balasubramanian

et al. 2021

JCM

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Acute lower extremity proximal deep venous thrombosis (DVT) requires accurate diagnosis and treatment in order to prevent embolization and other complications. Point-of-care ultrasound (POCUS), a clinician performed, and clinician interpreted bedside ultrasound examination has been increasingly used for DVT evaluation mainly in the urgent and critical care setting, but also in the ambulatory clinics and the medical wards. Studies have demonstrated that POCUS has excellent diagnostic accuracy for acute proximal DVT when performed by well-trained users. However, there is significant heterogeneity among studies on the necessary extent of training and universally acceptable standardized education protocols are needed. In this review, we summarize the evidence that supports the use of POCUS to diagnose acute proximal DVT and focus on methodology and current technology, sensitivity and specificity, pre-test probability and the role of D-dimer, time and resources, education, limitations, and future directions.

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It's Not All Deep Vein Thrombosis: Sonography of the Painful Lower Extremity With Multimodality Correlation

Cited by 15 publications

References 18 publications

A Rare Case of Limb-Threatening Injury Secondary to Extrinsic Vascular Compression Following Crocodile Bite

A Rare Case of Limb-Threatening Injury Secondary to Extrinsic Vascular Compression Following Crocodile Bite

Prevalence and predictors of alternative diagnoses on whole-leg ultrasound negative for acute deep venous thrombosis

The Use of Point-of-Care Ultrasound (POCUS) in the Diagnosis of Deep Vein Thrombosis

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