ANSWER: Vascular Doppler ultrasound of the lower extremities
This image demonstrates a non-compressive left popliteal vein in the left lower leg. The non-compressibility of the vessel indicates there is a thrombus within the vessel.
Other important details:
• A lower leg vascular ultrasound has low sensitivity but high specificity when evaluating for DVT
• 50% of patients with pulmonary embolus do not have DVT
• Ventilation/perfusion scans (V/Q scans) are indirect indicators of pulmonary artery thrombus and may be helpful in patient who cannot undergo a CT scan.
• V/Q scan
A V/Q scan does not directly visualize the clot, only the disruption of vascular perfusion
High sensitivity (~ 100%) but poor specificity
Limitation: High percentage of non-diagnostic intermediate probability scans (> 60%)
CT angiogram of the chest for pulmonary embolism: The preferred diagnostic test for evaluating for pulmonary embolism. It is a rapid test, non-invasive, and readily available.
TREATMENT OF PULMONARY EMBOLISM:
• Anticoagulation and fibrinolysis
Hemorrhage complications in 2-15%
• IVC filter if contraindications to drug therapy or for recurrent emboli
• pulmonary thromboendarterectomy (surgical removal of the thrombus)
Much less frequent
Indicated in patient with significant hemodynamic compromise
This patient was seen by a cardiothoracic surgeon, who deemed the patient not a surgical candidate. The patient was treated with intravenous heparin (anticoagulation).
|< Previous Page||Visit our Case of the Month Archive|