Ultrasound for Lower Extremity Deep Venous Thrombosis: Multidisciplinary Recommendations From the Society of Radiologists in Ultrasound Consensus Conference

Laurence Needleman; John J Cronan; Michael P Lilly; Geno J Merli; Srikar Adhikari; Barbara S Hertzberg; M Robert DeJong; Michael B Streiff; Mark H Meissner

doi:10.1161/CIRCULATIONAHA.117.030687

Ultrasound for Lower Extremity Deep Venous Thrombosis: Multidisciplinary Recommendations From the Society of Radiologists in Ultrasound Consensus Conference

Circulation. 2018 Apr 3;137(14):1505-1515. doi: 10.1161/CIRCULATIONAHA.117.030687.

Authors

Laurence Needleman¹, John J Cronan², Michael P Lilly³, Geno J Merli⁴, Srikar Adhikari⁵, Barbara S Hertzberg⁶, M Robert DeJong⁷, Michael B Streiff⁸, Mark H Meissner⁹

Affiliations

¹ Department of Radiology (L.N.) laurence.needleman@jefferson.edu.
² Department of Diagnostic Imaging, Brown University, Providence, RI (J.J.C.).
³ Department of Surgery, University of Maryland School of Medicine, Baltimore (M.P.L.).
⁴ Department of Medicine (G.J.M.), Thomas Jefferson University, Philadelphia, PA.
⁵ Department of Emergency Medicine, University of Arizona, Tucson (S.A.).
⁶ Department of Radiology, Duke University School of Medicine, Durham, NC (B.S.H.).
⁷ Department of Radiology (M.R.D.).
⁸ Department of Medicine (M.B.S.), Johns Hopkins School of Medicine, Baltimore, MD.
⁹ Department of Surgery, University of Washington School of Medicine, Seattle (M.H.M.).

PMID: 29610129
DOI: 10.1161/CIRCULATIONAHA.117.030687

Abstract

Venous ultrasound is the standard imaging test for patients suspected of having acute deep venous thrombosis (DVT). There is variability and disagreement among authoritative groups regarding the necessary components of the test. Some protocols include scanning the entire lower extremity, whereas others recommend scans limited to the thigh and knee supplemented with serial testing. Some protocols use gray-scale ultrasound alone, whereas others include Doppler interrogation. Point-of-care ultrasound is recommended in some settings, and there is heterogeneity of these protocols as well. Heterogeneity of recommendations can lead to errors including incorrect application of guidelines, confusion among requesting physicians, and incorrect follow-up. In October 2016, the Society of Radiologists in Ultrasound convened a multidisciplinary panel of experts to evaluate the current evidence to develop recommendations regarding ultrasound protocols for DVT and the terminology used to communicate results to clinicians. Recommendations were made after open discussion and by unanimous consensus.The panel recommends a comprehensive duplex ultrasound protocol from thigh to ankle with Doppler at selected sites rather than a limited or complete compression-only examination. This protocol is currently performed in many facilities and is achievable with standard ultrasound equipment and personnel. The use of these recommendations will increase the diagnosis of calf DVT and provide better data to explain the presenting symptoms. The panel recommends a single point-of-care protocol that minimizes underdiagnoses of proximal DVT.The panel recommends the term chronic postthrombotic change to describe the residual material that persists after the acute presentation of DVT to avoid potential overtreatment of prior thrombus.Adoption of a single standardized comprehensive duplex ultrasound and a single point-of-care examination will enhance patient safety and clinicians' confidence.

Keywords: diagnostic imaging; ultrasonography; veins; venous thromboembolism; venous thrombosis.

Publication types

Practice Guideline

MeSH terms

Acute Disease
Humans
Lower Extremity / diagnostic imaging*
Point-of-Care Systems
Recurrence
Societies, Medical
Ultrasonography / methods*
Venous Thrombosis / diagnosis*