Incremental value of compression ultrasound sonography in the emergency department

Abstract

The quick evaluation of venous thromboembolism is a key point of modern medicine since the delayed diagnosis is associated with a worse prognosis. Venous ultrasound (VU) is a sensitive and rapidly performed test in cases of suspected deep venous thrombosis. Various protocols have been proposed for its execution, such as the study of the whole deep venous circulation of the lower limb or the analysis of the femoral-popliteal area. The aim is to detect a vessel thrombus and the most sensitive element is the non-compressibility with the probe. Initially, the thrombus is hypoechogenic and adherent to the vessel; later, it tends to organize and recanalize. Usually, in the early stages, the risk of embolism is higher. The role of studying the iliac axis and calf veins is still uncertain. VU is not useful for assessing response to anticoagulation therapy and it is unclear whether the persistence of thrombotic abnormalities can guide on a possible prolongation of therapy.

Keywords: Compression ultrasound, Deep venous thrombosis, Venous ultrasound, Venous thromboembolism, Critical care ultrasonography

Core Tip: Venous ultrasound represents an important weapon for emergency setting care. Nevertheless, several different protocols present in the literature could create confusion. In this review our goal is to define a practical and clear guide to support the physician in rapid deep venous thrombosis diagnosis and correct management.