Rp. Beecham et al., IS BILATERAL LOWER-EXTREMITY COMPRESSION SONOGRAPHY USEFUL AND COST-EFFECTIVE IN THE EVALUATION OF SUSPECTED PULMONARY-EMBOLISM, American journal of roentgenology, 161(6), 1993, pp. 1289-1292
OBJECTIVE. Because deep venous thrombosis is clinically linked with pu
lmonary embolism and often treated similarly, we sought to assess the
usefulness of obtaining bilateral lower extremity compression sonogram
s when findings on ventilation-perfusion lung scans indicate a low or
indeterminate probability of pulmonary embolism. Demonstration of deep
venous thrombosis would provide a rationale for treating both pulmona
ry embolism and deep venous thrombosis. MATERIALS AND METHODS. Two hun
dred twenty-three consecutive patients with suspected pulmonary emboli
sm had ventilation-perfusion lung scans and concurrent bilateral lower
extremity compression sonograms; 34 also had pulmonary arteriography.
RESULTS. In 75 cases, the results of ventilation-perfusion lung scann
ing indicated an indeterminate probability of pulmonary embolism. Evid
ence of thrombosis was seen on sonograms in 11 of these 75. In the rem
aining 64, 17 underwent pulmonary arteriography and four (24%) had pul
monary embolism. Findings on lung scans indicated a low probability of
pulmonary embolism in 70 of 223 patients. Evidence of thrombosis was
seen on sonograms in 11 of these 70. Five of the remaining 59 underwen
t pulmonary arteriography and one (20%) had pulmonary embolism. Accord
ing to the 1993 Medicare Fee Schedule, if all 145 patients whose lung
scans were nondiagnostic had sonography and only those with normal son
ograms had pulmonary arteriography, the professional and hospital char
ges would be $359,552. If all 145 had pulmonary arteriography without
sonography, the charges would be $395,031. CONCLUSION. If ventilation-
perfusion lung scans indicate a low or an indeterminate probability of
pulmonary embolism and bilateral lower extremity compression sonograp
hy is performed, only those patients with normal sonographic findings
would need further study. Thus, 15% (22/145) of patients could be spar
ed pulmonary arteriography, and the estimated savings in cost would be
9%.