TY - JOUR
AU - Naidich, James B.
AB - Abstract • Blood clots that cause pulmonary embolism are reputed to arise in the lower extremities in 95% of cases and, therefore, testing with noninvasive venous studies has been recommended as a screening method. We evaluated plethysmography results and Doppler venous flow sounds for their concordance with pulmonary angiograms in a group of patients with suspected pulmonary embolism, and for their concordance with venograms in a second group of patients with suspected deep venous thrombosis. Fifty patients had both pulmonary angiograms and noninvasive venous studies. Of 16 patients with positive noninvasive studies, ten had angiograms positive for pulmonary embolism, and six had negative angiograms. Of 34 patients with negative noninvasive studies, 16 had positive pulmonary angiograms and 18 had negative angiograms. The positive predictive value was 63% and the negative predictive value was 53%. By contrast, in 125 patients with suspected deep venous thrombosis, the positive and negative predictive values of noninvasive studies were 94% and 92%, respectively. In this retrospective study, positive noninvasive examinations were useful clinically, but noninvasive venous studies were frequently negative in patients with documented pulmonary embolism and cannot be used to exclude this diagnosis. (Arch Intern Med 1987;147:505-507) References 1. Moser KM: Pulmonary embolism. Am Rev Respir Dis 1977;115:829-852. 2. Robin ED: Overdiagnosis and overtreatment of pulmonary embolism: The emperor may have no clothes. Ann Intern Med 1977;87:775-781.Crossref 3. Hull RJ, Hirsh J, Carter CJ, et al: Pulmonary angiography, ventilation lung scanning, and venography for clinically suspected pulmonary embolism with abnormal perfusion lung scan. Ann Intern Med 1983;98:981-989.Crossref 4. Cheely R, McCartney WH, Perry JR, et al: The role of noninvasive tests versus pulmonary angiography in the diagnosis of pulmonary embolism. Am J Med 1981;70:17-22.Crossref 5. McNeil BJ: A diagnostic strategy using ventilation-perfusion studies in patients suspect for pulmonary embolism. J Nucl Med 1976;17:613-616. 6. Hull RJ, Hirsh J, Carter CJ, et al: Diagnostic value of ventilation perfusion lung scanning in patients with suspected pulmonary embolism. Chest 1985;88:819-828.Crossref 7. Novelline RA, Bultarowich BH, Athanasoulis CA, et al: The clinical course of patients with suspected pulmonary emboli and a negative pulmonary arteriograph. Radiology 1978;126:561-567.Crossref 8. Sevitt S, Gallagher N: Venous thrombosis and pulmonary embolism: A clinicopathologic study in injured and burned patients. Br J Surg 1961;48: 475-489.Crossref 9. Having GO: Source of pulmonary emboli. Acta Chir Scand 1977;478 ( (suppl) ):2-7. 10. Moser KM, LeMoine JR: Is embolic risk conditioned by location of deep venous thrombosis? Ann Intern Med 1981;94:439-444.Crossref 11. Wheeler HB, O'Donnell JA, Anderson FA, et al: Occlusive impedance phlebography: A diagnostic procedure for venous thrombosis and pulmonary embolism. Prog Cardiovasc Dis 1974;17:199-205.Crossref 12. Darling RC, Raines VK, Brener BV, et al: Quantitative segmental pulse volume recorder: A clinical tool. Surgery 1972;72:872-887. 13. Hull RJ, Hirsh J, Sackett DL, et al: Replacement of venography in suspected venous thrombosis by impedance plethysmography and I-131-fibrinogen scanning. Ann Intern Med 1981;94:12-15.Crossref 14. Bell WR, Simon TL, DeMets DL: The clinical features of submassive and massive pulmonary emboli. Am J Med 1977;62:355-360.Crossref 15. Adelstein SJ, McNeil BJ: A new diagnostic test for pulmonary embolism: How good and how costly. N Engl J Med 1978;199:305-307.Crossref 16. Marsh JD, Glynn M, Torman HA: Pulmonary angiography: Application in a new spectrum of patients. Am J Med 1982;75:763-769.Crossref 17. Hull RJ, VanAken WG, Hirsh J: Impedance plethysmography using the occlusive cuff technique in the diagnosis of venous thrombosis. Circulation 1976;53:696-700.Crossref 18. Cranely JJ, Gay AY, Grass AM, et al: A plethysmographic technique for the diagnosis of deep venous thrombosis of the lower extremities. Surg Gynecol Obstet 1973;136:385-394. 19. McCandless ME, Young JR, Swift CL: Noninvasive diagnosis of clinically suspected deep venous thrombosis. Cleve Clin Q 1985;52:550-560.Crossref 20. Sasahara AA, Sharma GBRK, Parisi AF: New developments in the detection and prevention of venous thromboembolism. Am J Cardiol 1979;43:1214-1224.Crossref
TI - Noninvasive Venous Examinations as a Screening Test for Pulmonary Embolism
JF - Archives of Internal Medicine
DO - 10.1001/archinte.1987.00370030109021
DA - 1987-03-01
UR - https://www.deepdyve.com/lp/american-medical-association/noninvasive-venous-examinations-as-a-screening-test-for-pulmonary-yyeMQoXRZR
SP - 505
EP - 507
VL - 147
IS - 3
DP - DeepDyve
ER -