Duplex ultrasound examination of the acutely painful and swollen leg

The aim of this study was to assess the value of duplex ultrasound examination in establishing diagnosis in acutely swollen and painful lower limbs, and to examine how often the diagnosis of superficial and/or deep venous thrombosis can be made in the symptomatic legs.

Venous duplex scan examination was performed on 188 extremities of 180 ambulatory outpatients. The examination included testing patency and competency of the deep and superficial veins. The ultrasound study was also extended to finding soft tissue abnormalities.

Of the 188 lower limbs venous thrombosis was found on 82 occasions: 29 legs contained deep venous thrombosis only; 23 legs presented with superficial thrombophlebitis as a sole venous pathology; and in 30 cases superficial and deep venous thrombosis coexisted. In those 106 limbs where venous thrombosis was not present the most frequent positive ultrasound findings were incompetent leg veins or soft tissue masses (Baker's cyst and calf haematoma).

The variety of pathological processes related to the lower limb veins and the extravascular tissue suggest that routine, "detailed" ultrasound scanning would be indicated in all acutely symptomatic legs with a suspected venous disorder. The important diagnostic information so gained provides guidance to the most appropriate treatment strategy.