Venous Doppler Velocity Examination in Pulmonary Thromboembolism

The Doppler ultrasonic velocity detector, which is sensitive for deep vein thrombosis in 90% of cases demonstrated by venography in our institution, might be useful in the evaluation and management of patients with pulmonary thromboembolism (PE). This study describes the association of results of Doppler velocity examinations with the presence or absence of PE as documented by pulmonary angiography in 51 patients. Results are shown in the table. Doppler studies were performed within 48 hr of angiography.

Five patients with positive angiograms had initial or recurrent PE while on anticoagulants. Four of the 5 had positive Doppler studies and the fifth had an incomplete test because of a cast. One patient developed Doppler positivity 2 days before reembolization.

One conclusion is clear: Negative venous Doppler examinations must not be used to rule out PE. The study also raises 2 questions:1) Does negative Doppler examination at the time of PE represent complete embolization of thrombus and low risk of immediate recurrence? 2) Is positive Doppler study at the time of PE an indication for early venous plication?