Diagnostic approaches for detecting deep vein thrombosis.
Acute deep vein thrombosis remains a disease for which the diagnosis must be confirmed by an objective testing procedure. The current methods in use include continuous-wave Doppler, impedance plethysmography, and ultrasonic duplex scanning. The Doppler and plethysmographic methods are of value for the detection of proximal venous occlusion but do have limitations below the knee and fail to provide specific information concerning the exact location and extent of involvement. Duplex scanning, which has both imaging and flow detection capabilities, can be used from the level of the inferior vena cava to below the knee. When duplex scanning is used, the following variables are used in arriving at a diagnosis: visualization of the thrombus, lack of compressibility of the vein, and the absence of spontaneous and phasic flow from the large veins. When all of these variables are used in the screening process, the sensitivity and specificity will be in the range of 90% to 100%. Most false-positive results occur when the incompressibility variable is attempted for the iliac veins and the superficial femoral vein in the adductor canal. The majority of false negatives will be related to missed thrombi in the small veins of the calf.
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Division of Vascular Surgery, University of Washington School of Medicine, Seattle.
D006801:Humans; D010690:Phlebography; D010992:Plethysmography, Impedance; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D013924:Thrombophlebitis / Q000175:diagnosis / Q000000981:diagnostic imaging*; D014463:Ultrasonography / Q000379:methods