Original ArticlesLimitations of magnetic resonance imaging and ultrasound-directed (duplex) scanning in the diagnosis of subclavian vein thrombosis☆
Section snippets
Patients
The risk factor for subclavian vein thrombosis in all patients was the presence of a silicone rubber catheter placed in the vein.1 All but four examinations were performed as part of a prospective evaluation of thrombotic complications of central venous catheters. The experimental protocol was approved by the Institutional Review Board of the University of Nebraska Medical Center, and written informed consent was obtained from all participants. Participants in this study underwent diagnostic
Results
Forty-three arm phlebograms were obtained with duplex ultrasound examinations shortly thereafter. Twenty-eight of these phlebograms had MRI scans for correlation as well. The results are summarized in Table I and II.Empty Cell Empty Cell Results of phlebography Empty Cell Empty Cell Normal Partial occlusion Complete occlusion Normal 18 6 5* Duplex scan Partial occlusion — 8 — Complete occlusion — — 6 Total 43 18 14 11 *Occlusion of proximal portion of left subclavian vein.
Discussion
Real-time ultrasonography has been found to be useful in the diagnosis of venous thrombosis of the legs.2, 3 When applied to the subclavian veins this technique has been found helpful in a limited number of patients.4, 5, 6, 7 These four reports describe the ultrasound findings of 24 subclavian veins proven phlebography to be totally obstructed by thrombus. Ultrasound findings of only six normal veins on phlebography and no veins only partially occluded by thrombi have been reported.7
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2012, Journal of the American College of RadiologyCitation Excerpt :Diagnostic criteria for direct evidence of thrombus, as in the lower extremity, include loss of compression of imaged vein walls when pressure is applied on the skin during real-time imaging, and visualization of echogenic material in the vein. Indirect evidence of thrombus includes altered blood flow patterns [8,25-29]. Loss of compressibility is consistent with acute DVT but can also occur in the presence of chronic venous thrombosis [8,26].
Diagnosis of DVT: Antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines
2012, ChestCitation Excerpt :Table S58 provides a description of the study results, and Tables S59 to S65 present evidence profiles for the various diagnostic strategies that have been evaluated. Table 11 summarizes the quality of evidence and frequency of potential clinical outcomes for the various diagnostic strategies.217–228 Upper extremity DVT is diagnosed in the presence of noncompressibility of a venous segment (CUS) or in the absence of a color or Doppler signal within the lumen of the vein (visible intraluminal thrombus) and excluded in the absence of these findings.216,219,223–227
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Reprint requests: William D. Haire, MD, Department of Internal Medicine, University of Nebraska Medical Center, 42nd and Dewey, Omaha, NE 68105.