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Embolization of DVT Following Compression Venous Doppler Ultrasound
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A7036 - Embolization of DVT Following Compression Venous Doppler Ultrasound
Author Block: M. Walker1, I. Dalal1, W. Khan2; 1Internal Medicine, Robert Wood Johnson Medical School, New Brunswick, NJ, United States, 2Pulmonary and Critical Care, University Medical Center of Princeton at Plainsboro, Plainsboro, NJ, United States.
Introduction: Pulmonary embolism (PE) is a potentially fatal complication of deep venous thrombosis (DVT). Lower extremity compression doppler ultrasound (US) is the diagnostic test of choice to diagnose DVT. Although rare, manual compression during diagnostic lower extremity US can potentially dislodge a DVT and result in PE. We present a case of DVT after recent orthopedic surgery with resultant PE following lower extremity US.
Case: A 53 year-old female complained of right leg pain two weeks after right arthroscopy knee surgery. She presented to the ambulatory care center for lower extremity compression US. The study demonstrated extensive right lower extremity DVT. Minutes after the ultrasound she complained of severe chest pain and dyspnea. The patient became unresponsive and was transported to the emergency room. An emergent cardiac echocardiogram revealed right ventricular dilation and positive McConnell sign. An electrocardiogram showed an S1Q3T3 pattern. Cardiopulmonary resuscitation (CPR) was initiated due to cardiac arrest. Return of spontaneous circulation was achieved after approximately 8-12 minutes of CPR. Computed tomography of the chest revealed bilateral pulmonary emboli. Treatment was initiated with alteplase and heparin. The patient eventually made a full recovery and was discharged from the hospital on oral anticoagulation.
Discussion: While lower extremity US is the diagnostic test of choice for detection of DVT, there is a concern for possible dislodgement of clot into the pulmonary vasculature. A 2016 systematic review on embolization following lower extremity ultrasonography found that six out of eight patients became symptomatic within seconds to several hours after ultrasonography. Symptoms including dyspnea, pleuritic chest pain, and orthopnea1. No clear mechanism of has been found, however it is hypothesized the compression techniques used during ultrasonography caused dislodgement of vulnerable thrombi. Therefore, while clot embolization from DVT following diagnostic ultrasonography is rare, the clinician should be aware of this potentially fatal complication. Further research is needed to characterize vulnerable thrombi, and to assess ultrasonography compression techniques which could predispose to embolization.
Author Block: M. Walker1, I. Dalal1, W. Khan2; 1Internal Medicine, Robert Wood Johnson Medical School, New Brunswick, NJ, United States, 2Pulmonary and Critical Care, University Medical Center of Princeton at Plainsboro, Plainsboro, NJ, United States.
Introduction: Pulmonary embolism (PE) is a potentially fatal complication of deep venous thrombosis (DVT). Lower extremity compression doppler ultrasound (US) is the diagnostic test of choice to diagnose DVT. Although rare, manual compression during diagnostic lower extremity US can potentially dislodge a DVT and result in PE. We present a case of DVT after recent orthopedic surgery with resultant PE following lower extremity US.
Case: A 53 year-old female complained of right leg pain two weeks after right arthroscopy knee surgery. She presented to the ambulatory care center for lower extremity compression US. The study demonstrated extensive right lower extremity DVT. Minutes after the ultrasound she complained of severe chest pain and dyspnea. The patient became unresponsive and was transported to the emergency room. An emergent cardiac echocardiogram revealed right ventricular dilation and positive McConnell sign. An electrocardiogram showed an S1Q3T3 pattern. Cardiopulmonary resuscitation (CPR) was initiated due to cardiac arrest. Return of spontaneous circulation was achieved after approximately 8-12 minutes of CPR. Computed tomography of the chest revealed bilateral pulmonary emboli. Treatment was initiated with alteplase and heparin. The patient eventually made a full recovery and was discharged from the hospital on oral anticoagulation.
Discussion: While lower extremity US is the diagnostic test of choice for detection of DVT, there is a concern for possible dislodgement of clot into the pulmonary vasculature. A 2016 systematic review on embolization following lower extremity ultrasonography found that six out of eight patients became symptomatic within seconds to several hours after ultrasonography. Symptoms including dyspnea, pleuritic chest pain, and orthopnea1. No clear mechanism of has been found, however it is hypothesized the compression techniques used during ultrasonography caused dislodgement of vulnerable thrombi. Therefore, while clot embolization from DVT following diagnostic ultrasonography is rare, the clinician should be aware of this potentially fatal complication. Further research is needed to characterize vulnerable thrombi, and to assess ultrasonography compression techniques which could predispose to embolization.
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