[The asymptomatic lung embolism: should every patient with deep vein thrombosis be examined using thoracic...

Examination of the prognostic importance of sonographically diagnosed pleural defects in patients with deep vein thrombosis (DVT) who are clinically asymptomatic for lung emboli (LE).

n = 124 patients with a sonographically diagnosed DVT and without clinical symptoms for an LE were accepted for this retrospective study. The thorax was subsequently sonographically examined in all patients. The patients were split into two groups (group 1: with pleural defects; group 2: without pleural defects). These groups were observed for an average of 36.6 months. The endpoints death and recurrence of pulmonary embolism or thrombosis were documented. The survival time was calculated using the Kaplan-Meier analysis.

Of the 124 patients, n = 50 (40.3 %) had pleural defects (group 1) and n = 74 (59.7 %) had no pleural defects (group 2) on thoracic sonography. During the time of observation, n = 9 patients experienced a recurrent event of thrombosis or pulmonary embolism. In total, n = 39 (31.5 %) patients died (group 1: n = 16, group 2: n = 23 patients). The one-year mortality rate for patients with pleural defects was 24 % in group 1 and 22 % in group 2. The differences in the survival curves were not statistically significant (p = 0,7581).

The sonographic diagnosis of pleural defects that are indicative for small embolism for patients with diagnosed deep vein thrombosis (DVT) and without clinical symptoms for an LE has no prognostic significance with respect to death or recurrent pulmonary embolism or thrombosis. Routine thorax sonography for such patients does not seem to be indicated.