[Venous thromboembolism. "The emperor's new clothes" or a silent menace?]

The clinical picture at deep venous thrombosis and lung embolism is unspecific and the diagnosis is confirmed in only about 50 per cent of the patients by phlebography and lung angiography respectively. New contrast media have reduced the side-effects at phlebography. Of the non-invasive methods B mode ultrasound is a rapid, simple procedure with great diagnostic accuracy but lower leg thromboses cannot be demonstrated with the present equipment. High diagnostic accuracy has been attained at lung embolism by means of perfusion ventilation scintigraphy and lung angiography. ECG, acid-base status and thorax X-ray provide guidance and are of major significance for differential diagnosis. All cases of deep venous thrombosis above knee level should be treated with anticoagulants but such therapy is probably unnecessary for lower leg thromboses. Heparin is frequently given for three to six days. At the same time peroral anticoagulation therapy may be introduced and continue for one to three months after heparin treatment. Lung embolism is treated with anticoagulants if the patients are hemodynamically stable. The value of thrombolysis has not been determined but it is recommended for massive multiple and peripheral lung embolisms. Embolectomy should be considered in cases of massive central lung embolisms.