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Evaluation of the Lower Extremity Veins in Patients with Suspected Pulmonary Embolism

A Retrospective Comparison of Helical CT Venography and Sonography

¹ All authors: Department of Radiology, New York Presbyterian Hospital, Columbia University College of Physicians and Surgeons, Milstein Hospital Bldg., 2nd Fl., Fort Washington Ave., New York, NY 10032.

View larger version (111K): [in a new window]   Fig. 1A. —70-year-old man with deep venous thrombosis and pulmonary embolism revealed on CT venography and CT angiography. CT venographic image shows filling defect surrounded by rim of contrast material in left popliteal vein (arrow).

View larger version (116K): [in a new window]   Fig. 1B. —70-year-old man with deep venous thrombosis and pulmonary embolism revealed on CT venography and CT angiography. Adjacent CT venographic image again shows filling defect surrounded by rim of contrast material in left popliteal vein (arrow).

View larger version (145K): [in a new window]   Fig. 1C. —70-year-old man with deep venous thrombosis and pulmonary embolism revealed on CT venography and CT angiography. CT angiographic image reveals partial filling defect within pulmonary artery to left lower lobe (arrow).

View larger version (103K): [in a new window]   Fig. 1D. —70-year-old man with deep venous thrombosis and pulmonary embolism revealed on CT venography and CT angiography. Transverse gray-scale sonographic images of left popliteal vein obtained 5 days before A-C without (left image) and with (right image) compression reveal noncompressible left popliteal vein (arrows).

View larger version (174K): [in a new window]   Fig. 1E. —70-year-old man with deep venous thrombosis and pulmonary embolism revealed on CT venography and CT angiography. Transverse color Doppler sonographic image (shown in black and white) obtained 5 days before A-C reveals nonfilling of left popliteal vein (arrow).

View larger version (72K): [in a new window]   Fig. 1F. —70-year-old man with deep venous thrombosis and pulmonary embolism revealed on CT venography and CT angiography. Spectral Doppler sonographic image obtained 5 days before A-C reveals noise within left popliteal vein (arrow).

View larger version (125K): [in a new window]   Fig. 2A. —76-year-old woman with propagation of deep venous thrombosis and possible embolization. CT venographic image shows thrombus in right popliteal vein (arrow). This was isolated finding on sonogram obtained 3 days earlier (not shown).

View larger version (119K): [in a new window]   Fig. 2B. —76-year-old woman with propagation of deep venous thrombosis and possible embolization. CT venographic image shows extension of deep venous thrombosis into superficial femoral vein (arrow) after right femoral artery puncture complicated by large adductor compartment hematoma.

View larger version (103K): [in a new window]   Fig. 2C. —76-year-old woman with propagation of deep venous thrombosis and possible embolization. CT angiographic image shows partially occlusive thrombus in right lower lobe pulmonary artery (arrow).

View larger version (97K): [in a new window]   Fig. 3. —31-year-old woman with tiny thrombus seen on CT venography but not on sonography. CT venographic image shows tiny, nonocclusive filling defect in right common femoral vein (arrow). It is possible that this thrombus had developed since or had been overlooked on prior sonographic examination performed 2 days earlier.

View larger version (128K): [in a new window]   Fig. 4A. —Patients with possible deep venous thrombosis seen on single CT venographic images but not visible on sonography. CT venographic image of 27-year-old woman shows vague central filling defect in right superficial femoral vein (arrow).

View larger version (93K): [in a new window]   Fig. 4B. —Patients with possible deep venous thrombosis seen on single CT venographic images but not visible on sonography. CT venographic image of 55-year-old woman shows vague central filling defect in left popliteal vein (arrow).

View larger version (115K): [in a new window]   Fig. 5A. —66-year-old man with deep venous thrombosis identified on sonography but missed on CT venography. CT venographic image shows common femoral veins with subtle wall enhancement, dilatation (arrows), and perivenous and subcutaneous edema.

View larger version (102K): [in a new window]   Fig. 5B. —66-year-old man with deep venous thrombosis identified on sonography but missed on CT venography. CT venographic image shows superficial femoral arteries with dense arterial enhancement (arrows). This phenomenon may represent a poorly timed bolus, severe bilateral arterial insufficiency, or as in this case, probable delayed enhancement from extensive bilateral deep venous thrombosis.

View larger version (39K): [in a new window]   Fig. 6. —Bar chart shows distribution of examinations on basis of number of days separating helical CT venographic and sonographic examinations. Stripes = true-negative findings, white dots = true-positive findings, black dots - false-positive findings, solid = false-negative finding.

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