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Clinically Suspected Pulmonary Embolism: Use of Bilateral Lower Extremity US as the Initial Examination—A Prospective Study¹

¹ From the Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA 02215. Received October 2, 1998; revision requested November 19; revision received December 17; accepted January 27, 1999. Address reprint requests to R.G.S. (e-mail: rsheiman@caregroup.harvard.edu).

PURPOSE: To determine the prevalence of deep venous thrombosis (DVT) and evaluate the use of symptoms and risk factors as selection criteria in the patient population undergoing lower extremity ultrasonography (US) as an initial examination for suspected pulmonary embolism (PE).

MATERIALS AND METHODS: One hundred eighty-two consecutive patients referred for bilateral lower extremity US as the first examination for suspected PE were evaluated prospectively for predisposing factors and symptoms of DVT. Patients were placed into four groups: group 1, no symptoms or risk factors; group 2, both symptoms and risk factors; group 3, only risk factors; group 4, only symptoms. The prevalence of DVT detected at lower extremity US in each group was determined.

RESULTS: There were 89 patients in group 1, 12 in group 2, 43 in group 3, and 38 in group 4, with a DVT prevalence of 0%, 25%, 14%, and 24%, respectively. There was no significant difference in DVT prevalence between groups with symptoms or risk factors but a significant difference between these groups and the group lacking both symptoms and risk factors.

CONCLUSION: Lower extremity US as the initial examination in patients suspected of having PE should be used only in those patients who have symptoms or risk factors for DVT. This would substantially decrease the number of examinations performed without a decline in DVT detection.

Index terms: Embolism, pulmonary, 60.72 • Extremities, thrombosis, 93.751 • Thrombosis, US, 93.1298, 93.12983, 93.751 • Ultrasound (US), Doppler studies, 93.12983 • Veins, thrombosis, 93.751

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