Detection of pelvic vein thrombosis by magnetic resonance angiography in patients with acute pulmonary embolism and normal lower limb compression ultrasonography.
OBJECTIVE
In patients with proven acute pulmonary embolism (PE), a systematic search for "residual" deep vein thrombosis (DVT) using venography or compression duplex ultrasonography (CDUS) of the lower limbs is negative in 20 to 50% of patients. We hypothesized that undetectable pelvic vein thrombosis (from the external iliac vein to the inferior vena cava) could account for a substantial proportion of patients with negative CDUS findings. Using a noninvasive test, magnetic resonance angiography (MRA), the objective of the study was to assess the prevalence of pelvic DVT in patients with acute PEs and normal findings on lower limb CDUS.


METHODS
Prospective study.


METHODS
A 35-bed respiratory unit in a 680-bed Parisian teaching hospital.


METHODS
From June 1995 to October 1996, 24 patients (mean age, 49 years; age range, 18 to 83 years) with acute PEs and normal findings on lower limb CDUS underwent pelvic MRA.


RESULTS
MRA disclosed pelvic DVT in seven patients (29%). The common iliac vein was involved in five patients. Internal iliac vein (hypogastric) thrombosis was imaged in two patients, but no patients had DVT limited to this vein. Three patients underwent subsequent venography studies that confirmed the MRA findings. In three other patients, a new MRA at the end of anticoagulant therapy showed the resolution of the DVT.


CONCLUSIONS
Our data support the view that, among patients with negative findings on CDUS, a substantial proportion of the DVTs that are responsible for PE originates in the pelvic veins. This study provides additional arguments to suggest that MRA might become the reference test for the exploration of pelvic DVT.
Service de Pneumologie et de Radiologie, Hôpital Foch, Suresnes, France. jean-baptiste.stern@imm.fr
Jean-Baptiste
JB
Stern
Marc
M
Abehsera
Dominique
D
Grenet
Sylvie
S
Friard
Louis-Jean
LJ
Couderc
Antoine
A
Scherrer
Marc
M
Stern
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005602:France; D006801:Humans; D007084:Iliac Vein / Q000000981:diagnostic imaging; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000150:complications*; D012307:Risk Factors; D014463:Ultrasonography; D020246:Venous Thrombosis / Q000150:complications / Q000175:diagnosis*