Related Experiment Videos
On difficulties in diagnosing deep vein thrombosis in daily clinical work and research practice
O Björgell1, P E Nilsson, J A Nilsson
1Department of Diagnostic Radiology, Malmö University Hospital, Sweden. ola.bjorgell@rontgen.mas.lu.se
Insights
Accurate diagnosis of deep venous thrombosis (DVT) is challenging due to difficult-to-visualize veins. Combining phlebography and color Doppler ultrasonography (CDU) with scoring improves diagnostic accuracy, reducing risks like pulmonary embolism.
Area of Science:
- Vascular Medicine
- Diagnostic Imaging
Background:
- Deep venous thrombosis (DVT) diagnosis relies on imaging like phlebography or color Doppler ultrasonography (CDU) as clinical signs are often absent.
- Certain venous segments, including planta pedis, deep calf/thigh, and internal iliac veins, present diagnostic challenges.
Purpose of the Study:
- To highlight diagnostic difficulties in phlebography and CDU for DVT.
- To emphasize the clinical and laboratory consequences of inaccurate DVT diagnosis.
Main Methods:
- Review of diagnostic challenges in phlebography and CDU for DVT.
- Discussion of specific venous anatomies that are difficult to image.
- Emphasis on the need for a comprehensive diagnostic method.
Main Results:
- Inaccurate DVT diagnosis can lead to serious complications, including missed pulmonary embolism (false negative) or unnecessary anticoagulation (false positive).
- Difficult-to-visualize veins contribute to diagnostic uncertainty.
Conclusions:
- A combination of phlebography and CDU, alongside a strict scoring system, can enhance diagnostic accuracy for DVT.
- Improved diagnostic strategies are crucial for managing DVT and preventing severe outcomes.
Abstract:
This article enlightens the diagnostic difficulties when performing and interpreting a phlebography or color Doppler ultrasonography (CDU), which may have serious consequences in the daily clinical and laboratory work. In laboratory research as well as in clinical trials the most fundamental principle is to obtain a correct diagnosis. Less than 50% of patients with deep venous thrombosis (DVT) manifest the classical symptoms and signs of DVT and consequently the diagnosis is based upon methods such as phlebography or CDU. Some veins are especially hard to display, i.e. the veins of the planta pedis, the deep muscle veins of the calf and thigh and the deep internal iliac vein. Thus, the ideal diagnostic method must display the whole venous system from the planta pedis to the caval vein. A false negative examination puts the patient at risk of pulmonary embolism, which may present with a sudden onset and fatal outcome. A venous dysfunction as well as recurrent DVT will also be a continuous risk factor. A false positive interpretation may result in unnecessary anticoagulation treatment and bleeding complications. The combination of phlebography and CDU together with the strict use of a scoring method will increase the possibility of a proper diagnosis focusing on the diagnostically difficult areas of the venous system.