High prevalence of detectable deep venous thrombosis in patients with acute pulmonary embolism

Study objectives: Because specific studies are unavailable, the exact preva lence of detectable "residual" deep venous thrombosis (DVT) in patients wit h acute pulmonary embolism (PE) is unknown. Design: Review of clinical records and radiologic documents of consecutive patients. Setting: Pulmonary diseases and radiology departments at a univer sity hospital, Patients: All patients hospitalized in the Department of Pulmonary Diseases with a diagnosis of acute PE during a 5-year period (1984 to 1988), During this period, the diagnosis of PE was based exclusively on pulmonary angiog raphy, and bilateral lower limb venography was routine in patients with pro ven acute PE. Measurements and results: hmong 228 consecutive patients with angiography-p roven PE, 213 underwent bilateral lower limb venography within; 48 h of the diagnosis, Venography demonstrated DVT in 174 patients (81.7%; 95% confide nce interval, 76.5 to 86.9%), including 128 patients (60%) with proximal DV T, Signs or symptoms of DVT were present in only 72 patients (42%) with DVT . The prevalence of detectable DVT was-significantly lower in patients with recent pelvic surgery or delivery (6 of 12, 50%) than in the other patient s, whatever their individual risk factors (p < 0.05), The mean pulmonary va scular obstruction was significantly lower in patients with normal venograp hy than in patients with detectable DVT (37.6 +/- 20.9% vs 48.4 +/- 21.7%; p = 0.007), Conclusions: Lower limb venography demonstrates a high prevalence (82%) of residual DVT in patients with angiography-proven PE, These data should be t aken into account in the diagnostic and therapeutic management of patients with suspected or proven PE.