Prevalence and predictors of alternative diagnoses on whole-leg ultrasound negative for acute deep venous thrombosis
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RESEARCH ARTICLE
Open Access
Prevalence and predictors of alternative diagnoses on whole‑leg ultrasound negative for acute deep venous thrombosis Ebba Beller1†, Mattes Becher1†, Felix G. Meinel1* , Jens‑Christian Kröger1, Rengarajan Rajagopal2, Raimund Höft3, Marc‑André Weber1 and Thomas Heller1
Abstract Background: To investigate the prevalence, spectrum, and predictors of alternative diagnoses explaining leg symp‑ toms in patients negative for suspected acute deep venous thrombosis (DVT), which can be detected with whole-leg ultrasound. Methods: We retrospectively analyzed a cohort of 789 patients (median age 70 years, 50.6% women) evaluated with a whole-leg ultrasound examination for suspected acute DVT within one year. All findings in the radiology report were analyzed and electronic chart review was performed to collect clinical information. Results: Ultrasound was negative for acute DVT in 531 patients (67.3%). Among these, alternative diagnoses explain‑ ing leg symptoms were seen in 349 patients (65.7%). The most frequent alternative diagnoses were chronic venous insufficiency (147 patients, 27.7%), followed by lymphedema (48 patients, 9.0%) and chronic post-thrombotic changes (41 patients, 7.7%). Patients with alternative diagnoses were older (median 71 vs. 66 years, p = 0.0226), as well as more likely to present with leg swelling (39.5% vs. 23.1%, p = 0.0002), difference in leg circumference (25.5% vs. 14.8%, p = 0.0055) and redness (7.7% vs. 2.7%, p = 0.0213) than patients without alternative diagnosis. Independent predic‑ tors of finding alternative diagnoses on whole-leg ultrasound were older age (odds ratio 1.014 per year, p = 0.0119), leg swelling (OR 1.949, p = 0.0020) and history of previous DVT (OR 2.235, p = 0.0154). Conclusions: Alternative diagnoses explaining leg symptoms can be detected on whole-leg ultrasound in two thirds of patients with no evidence of acute DVT. Our data supports performing a comprehensive ultrasound evaluation beyond the venous system, particularly, in older patients, who present with leg swelling and a past history of DVT. Keywords: Deep venous thrombosis, Duplex ultrasound, Compression ultrasound Background Acute deep venous thrombosis (DVT) is a common condition for which patients seek emergency medical care and is associated with pulmonary embolism as *Correspondence: felix.meinel@med.uni‑rostock.de † Ebba Beller and Mattes Becher have contributed equally to this work 1 Institute of Diagnostic and Interventional Radiology, Paediatric Radiology and Neuroradiology, University Medical Centre Rostock, Ernst‑Heydemann‑Str. 6, 18057 Rostock, Germany Full list of author information is available at the end of the article
a potentially life-threatening complication. Therefore, accurate diagnosis and prompt initiation of anticoagulant therapy is important to reduce morbidity [1]. Clinical signs and symptoms of DVT are often vague [2] and laboratory D-dimer tests, routinely used for DVT screening, tend to have low specificity [3]. Duplex ultrasound of the lower extremi
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