1Department of clinical laboratory, Kirishima medical center, 2Department of radiology, Kirishima medical center, 3Department of cardiology, Kirishima medical center, 4Department of gastroenterology, Kirishima medical center
ultrasonography, deep venous thrombus, D-dimer
Purpose: We studied the prevalence of deep venous thrombus (DVT) in preoperative orthopedic patients who had sustained
leg injury. Materials and methods: Subjects of this study were 66 of the 129 adult individuals aged an average of 82.5 years who had been admitted to this institution for treatment of orthopedic disease of the legs from April 2002 through January 2005,those with D-dimer oncentrations in excess of 1.0μg ⁄ml above the normal range. We carried out ultrasonographic examination of deep venous thrombi from the bilateral external iliac vein to the calf muscle veins and evaluated the existence of deep venous thrombi, paying particular attention to (1) presence of thrombus echo in B-mode images, (2) vein compressibility, and
(3) absence of blood flow in the affected vein on compression of the muscles of the lower legs. Results: Twenty-six (39.4％) of these 66 patients had deep venous thrombi: In 1 patient, the deep venous thrombus was in the popliteal vein; in the remaining 25, thrombi were found in the veins of the lower legs. Twenty patients had deep venous thrombi in the injured leg; 10, in both
legs; and 4, in the leg uninjured leg. Fourteen of 26 patients had deep venous thrombi on the side opposite the site of injury.We found no significant difference in average D-dimer concentration in patients with deep venous thrombi (mean, 28.8μg ⁄ml) and those without these lesions (mean, 24.6 μg ⁄ml). Thirteen of 26 patients with less than 20.0μg ⁄ml of D-dimer had deep venous thrombi. Discussion: Although about 40 percent of patients with D-dimer values above the normal range had deep venous thrombi, their D-dimer values were not associated with the presence of deep venous thrombus. Almost all the patients studied had deep venous thrombi in the veins of their lower legs, and more than 50 percent of these patients had deep venous thrombi on the side opposite the site of injury, indicating that both legs, especially the lower legs, should be screened for deep venous thrombi. Conclusion: Ultrasonographic study of the legs of orthopedic patients with D-dimer concentration above the normal range was useful in evaluating presence of deep venous thrombus.