Lower extremity deep venous thrombosis in cancer patients: correlation of presenting symptoms with venous sonographic findings.

Abstract

ancer patients are at increased risk for the development of DVT. The clinical sequelae of DVT in this population are significant. In addition to the prolonged discomfort and swelling associated with chronic DVT, the presence of acute femoropopliteal DVT poses a grave risk of thromboembolic complications. Pulmonary embolism is a frequent cause of death among cancer patients. 1 Early diagnosis and treatment of DVT is vital to decrease these complications.Lower extremity deep venous sonography using compression and Doppler techniques is a quick, noninvasive, and accurate test with sensitivities of 89 to 95% and specificities of 92 to 100% in the diagnosis of acute femoropopliteal DVT. 2-5 For these reasons ultrasonography has now become the primary diagnostic imaging modality for suspected DVT in most clinical settings, largely replacing venography with its associated discomfort and risks associated with administration of contrast agents, including contrast agent-induced phlebitis. The clinical utility of lower extremity venous ultrasonography in the setting of bilateral leg edema and in the evaluation of suspected pulmonary embolism has, however, been a subject of debate in the recent literature.

Deep vein thrombosis (DVT) in advanced cancer patients with lower extremity edema referred for assessment

“…This result differs from another study where unilateral edema was the most common presentation of edema as a clinical sign suggesting underlying thrombosis in cancer patients. 8 However, the same study identified that 12/26 (46 percent) of patients with asymmetric bilateral edema also had a DVT. In a prospective study to determine the prevalence and associated variables of DVT in 258 hospice inpatients with advanced cancer, the majority of patients with DVT in one leg only had bilateral swelling.…”

“…10 Often bilateral edema is attributed to the underlying malignancy, treatment for the malignancy, or other clinical, metabolic, or endocrine disorders, and, more rarely, DVT. 8,[11][12][13][14] Thus, a DVT may be masked or misdiagnosed. 12,15 Our study supports the recommendation made by Loud and colleagues 8 that a difference in the degree of lower extremity edema should alert the clinician to an increased likelihood of DVT.…”

“…8,[12][13][14]16 In our study, there was limited documentation of other signs and symptoms apart from leg edema, and it appears that radiographic investigation to rule out DVT was ordered primarily on the basis of the presence of edema alone. Limited documentation may be secondary to the limited presence of these signs and symptoms or the lack of adequate documentation by the physicians.…”

“…Lower extremity venous sonography using compression and Doppler techniques is a quick, noninvasive, and accurate test with sensitivities of 89 to 95 percent and specificities of 92 to 100 percent in the diagnosis of acute femoropopliteal DVT. 8,9 The patients were scanned at the hospital radiology department using HDI 5000 ultrasound system, model year 2000 with pulsed and color Doppler capabilities.…”

Iliofemoral Venous Thrombosis Mainly Related to Iliofemoral Venous Obstruction by External Tumor Compression in Cancer Patients

“…Malignancy recurrence or posttreatment procedures, such as irradiation and/or surgery, can also lead to lymphatic obstruction. Vasogenic edema in malignancy is either related to venous stasis in the vessel lumen or a result of external tumor compression [2, 3]. …”