Colour flow imaging of calf vein thrombosis.

Ultrasound and more recently colour Doppler ultrasound has been successfully used in the diagnosis of lower limb venous occlusive disease. Colour Doppler ultrasound has shown promise in the diagnosis of calf vein thrombosis but to date there has been no prospective trial to specifically evaluate its potential. In view of this, we carried out a prospective trial of 50 patients comparing the accuracy of colour Doppler ultrasound with venography in the diagnosis of deep venous thrombosis both above and below knee but in particular with respect to the detection of calf vein clot. Of the 50 patients studied, 10 had only one imaging modality performed as there were eight venographic failures and two ultrasonic failures. Comparison was only thus possible in 40 cases. As in previous studies, colour Doppler ultrasound was shown to be accurate in the diagnosis of thrombosis within the femoro-popliteal veins and had a sensitivity and specificity of 100% respectively. With respect to calf vein lesions, there was one false negative scan using the ultrasonic technique giving a sensitivity of 95%, specificity of 100% and accuracy of 97.5%. We feel colour Doppler ultrasound can and should be used as a first line alternative to venography and can be employed for the exclusion of both above and below knee deep venous thrombosis. Venography should now be reserved for those patients who are unsuitable for ultrasound examination or who have an equivocal ultrasound scan.     

Pancreatitis-associated splenic vein thrombosis with intrasplenic venous thrombosis: a case report

Splenic vein thrombosis most often results from pancreatic disease and can result in gastrointestinal bleeding due to gastric varices. The diagnosis is becoming more frequent with the increasing utilization of imaging. This case report will review the imaging findings of splenic vein thrombosis with an illustration of the involvement of intrasplenic segmental venous branches.     

Deep vein thrombosis: significant limitations of noninvasive tests

Impedance plethysmography (IPG) has a reputed sensitivity of 95% in the detection of proximal, clinically significant deep venous thrombosis (DVT). A review of the radiologic studies of 100 consecutive patients who underwent both venography and IPG showed venographic evidence of proximal DVT in 40 patients. The IPG was negative in 15 (38%) of these 40 cases. The specificity of the IPG was 83%. The predictive value of a negative study, with this 40% prevalence of DVT, was 77%. These disturbing results indicate a continuing role for venography in the workup of DVT.     

Deep vein thrombosis after total hip replacement. A venographic study

The incidence of deep vein thrombosis (DVT) in 62 consecutive patients under dextran thromboprophylaxis after total hip replacement, was examined by venography of the legs on the second postoperative day. The venography was repeated on day 9 after the operation in 43 patients to study the development of thrombi. Twenty-one patients were found to have venographically deep vein thrombosis on the second postoperative day, but had no clinical signs of DVT. All thrombi were located distally in the leg and equally distributed between the operated and the non-operated leg. Distally located asymptomatic DVT were not given specific treatment. Thrombolysis between postoperative day 2 and day 9 seemed to dominate over thrombus formation and propagation. Even large thrombi in the legs may dissolve during the first postoperative week. Thus, the timing is essential for the screening of DVT.     

Deep vein thrombosis of the upper extremity: intra- and interobserver study of digital subtraction venography

Our objective was to assess the inter-observer and intra-observer agreement in the interpretation of digital subtraction venography (DSV) in patients with suspected deep vein thrombosis of the upper extremity (DVTUE). Prospectively, 62 consecutive DSV studies in 54 patients with clinically suspected DVTUE were included. Hard copies were presented without demographic data or original report. All venograms were read twice, at 3-month intervals, by an interventional vascular radiologist (observer 1) and an experienced general radiologist (observer 2). Consensus reading took place in the presence of a third experienced interventional radiologist. Inter-observer and intra-observer agreement were assessed using kappa statistics. Initial reading in 62 venograms showed an inter-observer agreement of 71% (kappa 0.48). The inter-observer agreement of the second reading was 83% (kappa 0.71). The agreement with the consensus report ranged from 76 to 94%. The intra-observer agreement for the first and second observer was 94% (kappa 0.89) and 76% (kappa 0.56), respectively (p<0.01). Digital subtraction venography has moderate to excellent intra- and inter-observer agreement, suggesting that digital subtraction venography is reliable for the diagnosis of DVTUE. Electronic Publication     

MRI in internal cerebral vein thrombosis: case note

A 40-year-old man developed general malaise, dizziness and progressive headache 1 week after acute haemorrhagic conjunctivitis. Bizarre behaviour, confusion and adversive seizures occurred later. MRI showed haemorrhagic infarct in the bilateral basal ganglia and thalamus and abnormal signal density in the internal cerebral veins. Bilateral carotid angiography showed no filling of superior sagittal sinus and internal cerebral veins. With MRI, cerebral venous thrombosis can be suspected and diagnosed earlier than before, obviating any invasive investigation.     

Deep vein thrombosis and pulmonary embolism: Clinical presentation and pathophysiologic consequences

Deep vein thrombosis (DVT) and pulmonary embolism (PE) are both characterized by unreliable clinical diagnosis and significant long-term sequelae. In patients with DVT, popliteal valvular insufficiency is associated with increased risk for postphlebitic syndrome. Current data show thrombolytic therapy to be more effective than anticoagulation for DVT, accomplishing significant or complete clearing of the deep venous system in nearly half of all patients treated. Results of investigation show lytic therapy to also be more, effective than heaparin in treatment of PE, both in terms of acute resolution and long-term function.     

Circumflex femoral vein thrombosis misinterpreted as acute hamstring strain

The case of a 24-year-old female professional, long-distance runner who presented with acute proximal posterior thigh pain is reported. History and clinical findings were consistent with acute hamstring strain but MRI demonstrated circumflex femoral vein thrombosis. This is the first case of proximal posterior thigh pain caused by circumflex femoral vein thrombosis reported in the literature. Doctors dealing with sports injuries should be aware of this clinical entity that mimics hamstring strain.     

Intracerebral haemorrhage from a venous angioma following thrombosis of a draining vein

We report a case of putaminal haemorrhage from a venous cerebral angioma following thrombosis in a draining vein. The patient complained of numbness of the right side, followed by headache and aphasia. CT demonstrated an intracerebral haemorrhage due to thrombotic occlusion of a draining vein of the venous angioma. Carotid angiography showed the venous angioma. MRI studies confirmed the diagnosis and demonstrated recanalisation of the draining vein following therapy with phenprocoumon. Received: 17 October 1996 Accepted: 14 May 1997     

Axillary vein thrombosis and congenital dysfibrinogenemia in a commercial pilot: a case report

A 34-yr-old male commercial pilot developed a painful swollen right upper arm following an episode of trauma. Venography confirmed the clinical diagnosis of a right axillary deep venous thrombosis. Magnetic resonance imaging suggested the presence of a fibrous tissue band overlying the junction of the right subclavian and innominate veins, potentially creating a thoracic outlet syndrome. A thrombophilia screen revealed an abnormal fibrinogen variant consistent with a diagnosis of congenital dysfibrinogenemia. The pilot was treated with anticoagulant therapy for 4 mo. There were diagnostic difficulties in determining the definitive etiology of the axillary vein thrombosis. Congenital dysfibrinogenemia is a rare condition, which is asymptomatic in the majority, but may manifest with hemorrhage or thrombosis in up to 45% of cases. The clinical management of the pilot and the aeromedical implications of the diagnosis are discussed.     

Deep vein thrombosis: scintigraphic diagnosis with In-111-labeled monoclonal antifibrin antibodies

Fifty-two patients suspected of having deep vein thrombosis under-went scintigraphy with an indium-111-labeled monoclonal antifibrin antibody. Venography disclosed deep vein thrombosis in 31 patients. With the whole limb considered an anatomic entity, antifibrin antibody scintigrams obtained 2 hours after injection had a specificity and sensitivity of 81% and 84%, respectively. A higher sensitivity (92%) was found for a subgroup of patients (n = 44) with symptoms for less than 10 days. Regional sensitivities for all patients and for the subgroup, respectively, were 92% and 100% in the calf, 82% and 94% in the popliteal region, 63% and 71% in the thigh, and only 18% and 13% in the pelvis. Additional imaging performed 6 hours and 21 hours after injection in 12 patients and quantitative analysis done from scintigrams with and without blood-pool (technetium-99m human serum albumin) correction did not improve sensitivity. In-111-antifibrin antibody scintigraphy is an accurate method for diagnosis of acute established deep vein thrombosis of the calf and popliteal region; its sensitivity in the thigh is lower, and it is not feasible for diagnosis in the pelvic area.     

Renal scintigraphic findings in a case of transplant renal vein thrombosis

Renal vein thrombosis is a rare complication of renal transplantation. The scintigraphic features of a documented case of renal vein thrombosis studied with Tc-99m DTPA and the differential diagnosis relevant to these findings are discussed.     

Hepatopetal collaterals after portal vein thrombosis following liver transplantation

Two liver transplant patients with hepatopetal collaterals after portal vein thrombosis are described. Angiographically, the appearance is similar to cavernous transformation of the portal vein. The demonstration of hepatopetal collaterals is diagnosic of portal vein occlusion from whatever cause. After portal vein occlusion, collaterals develop from preexisting periportal vessels which undergo compensatory enlargement and reconstitute the intraheptic portal vessels. In liver transplant patients, the collateral communications must arise de novo, since all potential collateral pathways are severed at the time of transplantation.