Isolated nonfilling of contrast in deep leg vein segments seen on phlebography, and a comparison with color Doppler ultrasound, to assess the incidence of deep leg vein thrombosis

Nonfilling of contrast in deep veins on phlebography is claimed to be an in direct sign of deep vein thrombosis (DVT) by some authors but rejected by o thers. The aim of this study was to prospectively assess, with color Dopple r ultrasound (CDU), the occurrence and distribution of DVT in isolated, non filling, deep vein segments seen on a phlebogram. One hundred consecutive p atients with clinical signs of acute DVT, in whom phlebography displayed no nfilling of the posterior tibial veins and/or the deep calf muscle veins, w ere examined with CDU on the same occasion. Ultrasound confirmed a DVT in 3 1 (31%) patients; in another 38 (38%) patients other pathology, without con comitantly detected DVT, such as edema, bleedings, ligament and muscle rupt ures, Baker cysts, or superficial thrombophlebitis were found instead; and in the remaining 31 (31%) patients no pathology that could explain the nonf illing was identified. Isolated, nonfilling of the posterior tibial and/or deep muscle veins of the calf found by phlebography may be an indirect sign of DVT but is equally commonly caused by other pathological conditions or arises without any detectable explanation. When the thrombotic burden is to be scored, and to facilitate the establishment of the correct diagnosis, a dditional CDU is recommended when isolated nonfilling is present.