Is it useful to also image the asymptomatic leg in patients with suspected deep vein thrombosis?

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Is it useful to also image the asymptomatic leg in patients with suspected deep vein thrombosis?

J Thromb Haemost. 2015 Jan 20;

Authors: Le Gal G, Robert-Ebadi H, Carrier M, Kearon C, Bounameaux H, Righini M

BACKGROUND: Venous ultrasonography is the cornerstone of the diagnostic work-up in patients with suspected deep vein thrombosis (DVT). Significant variations exist in clinical practice between centers and/or countries, e.g. proximal vs. whole-leg ultrasound, serial vs. single test, combination with clinical probability and D-Dimer. Less data exist on the need for bilateral leg imaging.
OBJECTIVES: To assess the yield of bilateral leg ultrasonography in patients with suspected DVT.
PATIENTS AND METHODS: A retrospective cohort study of consecutive patients seen with clinically suspected DVT. A single whole-leg ultrasound was performed in all patients. We extracted information on demographics, risk factors, clinical signs, pretest probability, side of clinical suspicion and ultrasound results.
RESULTS AND CONCLUSIONS: Among the 2,804 included patients, 609 (21.8%) patients had a positive ultrasound. A total of 20 patients (0.8%; 95% CI: 05 to 1.2%) had a thrombus diagnosed in both the symptomatic and asymptomatic legs. Moreover, five patients (0.2%; 95% CI: 0.1 to 0.5%) did not have a thrombus in the symptomatic leg but had a thrombus in the asymptomatic leg. Two out of 2,540 patients with unilateral symptoms had no proximal DVT in the symptomatic leg and a proximal DVT in the asymptomatic leg: 0.08% (95% CI: 0.0 to 0.3%). In summary, systematic imaging of both legs in patients with suspected DVT has a very low yield and, therefore, does not appear to be justified. This article is protected by copyright. All rights reserved.

PMID: 25604398 [PubMed - as supplied by publisher]

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