[en] The aim of our study is to investigate prospectively the quantitative relationship between deep venous thrombosis (DVT) and acute pulmonary embolism (PE). 110 patients clinically suspected of having venous thromboembolic disease underwent combined CT pulmonary angiography (CTPA) and venography of lower limb veins. 44 patients presented with clinical signs of DVT and positive ultrasonography or ascending venography, but no clinical sign of PE (Group 1). 66 patients presented with clinical signs of PE and positive CTPA (Group 2). Clot load in lower limb veins and pulmonary arteries were scored by two independent readers, each using two separate systems for DVT and two for PE. 27 (61%) patients in Group 1 also had PE, and 55 (83%) patients in Group 2 also had DVT. Correlations between PE and DVT scores were weak but statistically significant in Group 2 (r(s) ranging from 0.470-0.520; p< or =0.001), but only some were significant in Group 1 (r(s) ranging from 0.253-0.318; p-values ranging from 0.035-0.097). In conclusion, although PE occurs in a majority of patients with DVT, and vice versa, the amount/burden of clot load in one condition does not necessarily indicate - or indicates only weakly - the degree of burden in the other condition.
Hull RD, Hirsh J, Carter CJ, Jay RM, Dodd PE, Ockelford PA, et al. Pulmonary angiography, ventilation lung scanning, and venography for clinically suspected pulmonary embolism with abnormal perfusion lung scan. Ann Intern Med 1983;98:891-9.
Moser KM, Fedullo PF, LitteJohn JK, Crawford R. Frequent asymptomatic pulmonary embolism in patients with deep venous thrombosis. JAMA 271:223-5.
Wells PS, Ginsberg JS, Anderson DR, Kearon C, Gent M, Turpie AG, et al. Use of a clinical model for safe management of patients with suspected pulmonary embolism. Ann Intern Med 1998;129:997-1005.
Girard P, Musset D, Parent F, Maitre S, Phlippoteau C, Simonneau G. High prevalence of detectable deep venous thrombosis in patients with acute pulmonary embolism. Chest 1999;116:903-8.
Tapson VF, Carroll BA, Davidson BL, Elliott CG, Fedullo PF, Hales CA, et al. The diagnostic approach to acute venous thromboembolism. Clinical practice guideline. merican Thoracic Society. Am J Respir Crit Care Med 1999;160:1043-66.
opez-Beret P, Pinto JM, Romero A, Orgaz A, Fontcuberta J, blas M. Systematic study of occult pulmonary throm-boembolism in patients with deep venous thrombosis. Vasc Surg 2001;33:515-21.
orst-Krafek B, Fink AM, Lipp C, Umek H, Kohn H, Steiner A. Proximal extent of pelvic vein thrombosis and its association with pulmonary embolism. J Vasc Surg 2003 37:518-22.
Schoepf UJ, Costello P. CT angiography for diagnosis of pulmonary embolism: state of the art. Radiology 2004;230:329-37.
Perrier A, Roy PM, Aujesky D, Chagnon I, Howarth N, Gourdier AL, et al. Diagnosing pulmonary embolism in outpatients with clinical assessment, D-dimer measurement, venous ultrasound, and helical computed tomography: a multicenter management study. Am J Med 2004;116:291-9.
Wildberger JE, Mahnken AH, Das M, Kuttner A, Lell M, Gunther RW. CT imaging in acute pulmonary embolism: diagnostic strategies. Eur Radiol 2005;15:919-29.
Elias A, Cazanave A, Elias M, Chabbert V, Juchet H, Paradis H, et al. Diagnostic management of pulmonary embolism using clinical assessment, plasma D-dimer assay, complete lower limb venous ultrasound and helical computed tomography of pulmonary arteries. A multicentre clinical outcome study. Thromb Haemost 2005;93:982-8.
Perrier A, Roy PM, Sanchez O, Le Gal G, Meyer G, Gourdier AL, et al. Multidetector-row computed tomography in suspected pulmonary embolism. N Engl J Med 2005;352:1760-8.
Wood KE. Major pulmonary embolism: review of a pathophysiologic approach to the golden hour of hemody- namically significant pulmonary embolism. Chest 2002;121:877-905.
Fedullo PF, Tapson VF. Clinical practice. The evaluation of suspected pulmonary embolism. N Engl J Med 2003;349:1247-56.
Huisman MV, Buller HR, ten Cate JW, van Royen EA, Vreeken J, Kersten MJ, et al. Unexpected high prevalence of silent pulmonary embolism in patients with deep venous thrombosis. Chest 1989;95:498-502.
Gouzien P, Chabierski M, Baccialone J, Jeanbourquin D. Asymptomatic pulmonary embolism and venous thrombosis of the lower limbs. Study with spiral X-ray computed tomography. J Radiol 1996;77:125-8.
Monreal M, Ruiz J, Fraile M, Bonet M, Davant E, Muchart J, Vallejos V. Prospective study on the usefulness of lung scan in patients with deep vein thrombosis of the lower limbs. Thromb Haemost 2001;85:771-4.
Mastora I, Remy-Jardin M, Masson P, Galland E, Delannoy V, Bauchart JJ, et al. Severity of acute pulmonary embolism: evaluation of a new spiral CT angiographic score in correlation with echocardiographic data. Eur Radiol 2003;13:29-35.
Qanadli SD, El Hajjam M, Vieillard-Baron A, Joseph J, Mesurolle B, Oliva VL, et al. New CT index to quantify arterial obstruction in pulmonary embolism: comparison with angiographic index and echocardiography. AJR Am J Roentgenol 2001;176:1415-20.
Bjorgell O, Nilsson PE, Svensson PJ, Bergqvist D. A new scoring system for the detailed description of the distribution and thrombotic burden in deep leg vein thrombosis. Angiology 1999;50:179-87.
Ouriel K, Greenberg RK, Green RM, Massullo JM, Goines DR. A volumetric index for the quantification of deep venous thrombosis. J Vasc Surg 1999;30:1060-6.
Kistner RL, Ball JJ, Nordyke RA, Freeman GC. Incidence of pulmonary embolism in the course of thrombophlebitis of the lower extremities. Am J Surg 1972;124:169-76.
Martin F, Leroyer C, Oger E, Bressollette L, Andre N, Nonent M, et al. Pulmonary embolism and the level of thrombosis. A prospective study of 155 patients. Rev Mal Respir 1995;12:465-9.
Lusiani L, Visona A, Bonanome A, Pesavento R, Zanco P. The characteristics of the thrombi of the lower limbs, as detected by ultrasonic scanning, do not predict pulmonary embolism. Chest 1996;110:996-1000.
Meignan M, Rosso J, Gauthier H, Brunengo F, Claudel S, Sagnard L, et al. Systematic lung scans reveal a high frequency of silent pulmonary embolism in patients with proximal deep venous thrombosis. Arch Intern Med 2000;160:159-64.
Fink AM, Mayer W, Steiner A. Extent of thrombus evaluated in patients with recurrent and first deep vein thrombosis. J Vasc Surg 2002;36:357-60.
Simonneau G, Sors H, Charbonnier B, Page Y, Laaban JP, Azarian R, et al. A comparison of low-molecular-weight heparin with unfractionated heparin for acute pulmonary embolism. The THESEE Study Group. Tinzaparine ou Heparine Standard: Evaluations dans l'Embolie Pulmonaire. N Engl J Med 1997;337:663-9.
BjoÖrgell O, Nilsson PE, Benoni G, Bergqvist D. Symptomatic and asymptomatic deep vein thrombosis after total hip replacement. Differences in phlebographic pattern, described by a scoring of the thrombotic burden. Thromb Res 2000;99:429-38.
Bankier AA, Janata K, Fleischmann D. Severity assessment of acute pulmonary embolism with spiral CT: evaluation of two modified angiographic scores and comparison with clinical data. J Thor Imag 1997;12:150-8.
Collomb D, Paramelle PJ, Calaque O, Bosson JL, Vanzetto G, Barnoud D, et al. Severity assessment of acute pulmonary embolism: evaluation using helical CT. Eur Radiol 2003;13:1508-14.
Metafratzi ZM, Vassiliou MP, Maglaras GC, Katzioti FG, Constantopoulos SH, Katsaraki A, et al. Acute pulmonary embolism: correlation of CT pulmonary artery obstruction index with blood gas values. AJR Am J Roentgenol 2006;186:213-9.
Loud PA, Katz DS, Bruce DA, Klippenstein DL, Grossman ZD. Deep venous thrombosis with suspected pulmonary embolism: detection with combined CT venography and pulmonary angiography. Radiology 2001;219:498-502.
Remy-Jardin M, Remy J, Artaud D, Deschildre F, Duhamel A. Peripheral pulmonary arteries: optimization of the spiral CT acquisition protocol. Radiology 1997;204:157-63.
Wells PS, Anderson DR, Bormanis J. Value of assessment of pretest probability of deep-vein thrombosis in clinical management. Lancet 1997;350:1795-8.
Altman DG. Comparing groups - continuous data. In: Altman DG, editor. Practical statistics for medical research. London, UK: Chapman & Hall/CRC, 1999: 210-2.
