PULMONARY-EMBOLISM IS ASSOCIATED WITH THE COMBINATION OF ISOLATED CALF VEIN-THROMBOSIS AND RESPIRATORY SYMPTOMS

Purpose: Overall prevalence of pulmonary embolism (PE) in patients wit h deep venous thrombosis (DVT) isolated to calf veins is low. However, the prevalence of PE in the subgroup of patients with respiratory sym ptoms and isolated calf vein thrombosis (CVT) is unknown. Such informa tion is important in determining whether patients with CVT only and re spiratory symptoms should undergo evaluation for PE. The purpose of th is study was to determine the prevalence of PE in patients with respir atory symptoms and isolated CVT. Methods: From 1992 through 1994, all patients assessed by duplex scanning for lower extremity DVT were revi ewed, and those found to have isolated CVT and lower extremity or resp iratory symptoms were identified. Patients who had respiratory symptom s or later developed respiratory symptoms in addition to lower extremi ty symptoms underwent pulmonary angiography or ventilation/perfusion ( V/Q) scanning. Positive results on pulmonary arteriograms or ''high pr obability'' V/Q scans were considered diagnostic of PE. Results: There were 105 patients with isolated CVT and symptoms. Twenty-six patients had respiratory symptoms; nine (35%) had PE, and two died. Seventy-ni ne patients had only lower extremity complaints; five later developed respiratory symptoms. All five had PE and none had progression of CVT on repeat duplex scanning. Neither age, gender, prior DVT/PE, obesity, pregnancy, medication, known malignancy, smoking; recent surgery, or trauma predicted PE. Conclusions: Patients with respiratory symptoms a nd duplex diagnosed isolated CVT have a high prevalence of PE and requ ire pulmonary angiographic or V/Q scanning to rule out PE.