title: Contribution of indirect computed tomographic venography to the diagnosis of postpartum venous thromboembolism.
abstract: BACKGROUND
  The diagnostic value of indirect computed tomographic venography (CTV), following thoracic computed tomographic angiography (CTA), has not been specifically evaluated in postpartum patients with suspected pulmonary embolism.
  
  
  OBJECTIVE
  To assess the diagnostic value of CTV in postpartum venous thromboembolism.
  
  
  METHODS
  We reviewed all CTA and CTV procedures performed during the last 7 years in our institution for suspected pulmonary embolism during the postpartum period. We focused on the quality of CTA, the rates of positive CTA and isolated positive CTV findings, and alternative diagnoses provided by CTV.
  
  
  RESULTS
  Fifty-five CTA and 33 CTV procedures were performed for suspected pulmonary embolism in 47 patients referred between 24 h and 2 months after Cesarean (34 patients) or vaginal (13 patients) delivery. Of the 33 patients who had both CTA and CTV, seven had positive CTA findings and four had isolated positive CTV findings. Thus, the absolute increase in the venous thromboembolism detection rate following CTV was 12.1% [95% confidence interval (CI) 4.0-29.1]. Subcapsular hematoma of the liver or spleen was found on CTV in another two patients without venous thromboembolism. Consequently, CTV had a direct impact on clinical management in six of 33 patients (18%).
  
  
  CONCLUSIONS
  Our results suggest that postpartum patients with suspected pulmonary embolism have a significant rate of pelvic vein thrombosis and that the use of CTV leads to a 31% relative increase in the detection rate of venous thromboembolism as compared to CTA alone in these patients.
authors.affiliation: Radiology Department, Hopital Europeen Georges Pompidou, APHP, Faculte de Medicine, Universite Paris Descartes, Paris, France.
authors.forename: M P
authors.initials: MP
authors.lastname: Revel
authors.forename: O
authors.initials: O
authors.lastname: Sanchez
authors.forename: S
authors.initials: S
authors.lastname: Dechoux
authors.forename: S
authors.initials: S
authors.lastname: Couchon
authors.forename: G
authors.initials: G
authors.lastname: Frija
authors.forename: J
authors.initials: J
authors.lastname: Cazejust
authors.forename: G
authors.initials: G
authors.lastname: Chatellier
authors.forename: G
authors.initials: G
authors.lastname: Meyer
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D010690:Phlebography / Q000379:methods*; D049590:Postpartum Period; D011247:Pregnancy; D011860:Radiography, Abdominal; D014057:Tomography, X-Ray Computed / Q000379:methods*; D054556:Venous Thromboembolism / Q000175:diagnosis*