Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health

Introduction: Emergency physician-performed compression ultrasonography focuses primarily onthe evaluation of the proximal veins of the lower extremity in patients with suspected deep venousthrombosis (DVT). A detailed sonographic evaluation of lower extremity is not performed. Theobjective of this study was to determine the prevalence of non-thrombotic findings on comprehensivelower extremity venous duplex ultrasound (US) examinations performed on emergency department(ED) patients.

Methods: We performed a retrospective six-year review of an academic ED’s records of adultpatients who underwent a comprehensive lower extremity duplex venous US examination for theevaluation of DVT. The entire US report was thoroughly reviewed for non-thrombotic findings.

Results: We detected non-thrombotic findings in 263 (11%, 95% CI [9.5-11.9%]) patients. Amongthe non-thrombotic findings, venous valvular incompetence (81, 30%) was the most frequent,followed by cyst/mass (41, 15%), lymphadenopathy (33, 12%), phlebitis (12, 4.5%), hematoma (8,3%), cellulitis (1, 0.3%) and other (6, 2.2%).

Conclusion: In our study, we detected a variety of non-thrombotic abnormalities on comprehensive lowerextremity venous duplex US examinations performed on ED patients. Some of these abnormalities couldbe clinically significant and potentially be detected with point-of-care lower extremity US examinationsif the symptomatic region is evaluated. In addition to assessment of the proximal veins for DVT, werecommend sonographic evaluation of the symptomatic area in the lower extremity when performingpoint-of-care ultrasound examinations to identify non-thrombotic abnormalities that may requireimmediate intervention or close follow up. [West J Emerg Med. 2015;16(2):250–254.]