Usefulness of the Computed Tomography Venography for Evaluation of Leg Edema Including Deep Vein Thrombosis in Rehabilitation Patients
Identifieur interne : 006F06 ( Ncbi/Merge ); précédent : 006F05; suivant : 006F07Usefulness of the Computed Tomography Venography for Evaluation of Leg Edema Including Deep Vein Thrombosis in Rehabilitation Patients
Auteurs : Ji Hea Chang [Corée du Sud] ; Ho Jun Lee [Corée du Sud] ; Jae Hyun Kwon [Corée du Sud] ; Gi Hyeong Ryu [Corée du Sud] ; Heebong Moon [Corée du Sud] ; Changjae Kim [Corée du Sud] ; Ki Yeon Nam [Corée du Sud] ; Bum Sun Kwon [Corée du Sud]Source :
- Annals of Rehabilitation Medicine [ 2234-0645 ] ; 2014.
Abstract
To investigate the usefulness of computed tomography venography (CTV) for evaluation of leg swelling, especially deep vein thrombosis (DVT), in rehabilitation patients.
A hundred twenty-three patients, who had performed CTV performed because of suspected DVT in our clinic, were enrolled. We performed chart reviews retrospectively and categorized CTV findings as follows: DVT distal to inguinal ligament and no compression lesion; DVT proximal to inguinal ligament and no compression lesion; DVT distal to inguinal ligament and anatomical variant (for example, May-Thurner syndrome); DVT due to compression of mass (cancer or cyst); DVT and other incidental abnormal finding; and no DVT and other possible causes of leg swelling.
DVTs were found in 65 (53%) patients. DVTs were found at distal level (thigh or lower leg) to inguinal ligament in 47 patients. DVTs were found at proximal to inguinal ligament, usually undetectable with duplex ultrasonography, in 6 patients. DVTs caused by external compression, such as femoral vein and cancer mass, were found in 12 patients (10%), which are also not easily detected with duplex ultrasonography. Other various causes of leg edema without DVT were found in 22 (18%) patients.
CTV can evaluate more extensively venous problems in the pelvis and abdomen and detect other possible causes of leg swelling. Therefore, CTV can be a useful tool not only for easy detection of DVT but also for evaluating differential diagnosis of leg edema in rehabilitation patients.
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DOI: 10.5535/arm.2014.38.6.812
PubMed: 25566481
PubMed Central: 4280378
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Usefulness of the Computed Tomography Venography for Evaluation of Leg Edema Including Deep Vein Thrombosis in Rehabilitation Patients</title><author><name sortKey="Chang, Ji Hea" sort="Chang, Ji Hea" uniqKey="Chang J" first="Ji Hea" last="Chang">Ji Hea Chang</name><affiliation wicri:level="1"><nlm:aff id="A1">Department of Physical Medicine & Rehabilitation, Dongguk University College of Medicine, Goyang, Korea.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Corée du Sud</country><wicri:regionArea>Department of Physical Medicine & Rehabilitation, Dongguk University College of Medicine, Goyang</wicri:regionArea><wicri:noRegion>Goyang</wicri:noRegion></affiliation></author><author><name sortKey="Lee, Ho Jun" sort="Lee, Ho Jun" uniqKey="Lee H" first="Ho Jun" last="Lee">Ho Jun Lee</name><affiliation wicri:level="1"><nlm:aff id="A1">Department of Physical Medicine & Rehabilitation, Dongguk University College of Medicine, Goyang, Korea.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Corée du Sud</country><wicri:regionArea>Department of Physical Medicine & Rehabilitation, Dongguk University College of Medicine, Goyang</wicri:regionArea><wicri:noRegion>Goyang</wicri:noRegion></affiliation></author><author><name sortKey="Kwon, Jae Hyun" sort="Kwon, Jae Hyun" uniqKey="Kwon J" first="Jae Hyun" last="Kwon">Jae Hyun Kwon</name><affiliation wicri:level="1"><nlm:aff id="A2">Department of Radiology, Dongguk University College of Medicine, Goyang, Korea.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Corée du Sud</country><wicri:regionArea>Department of Radiology, Dongguk University College of Medicine, Goyang</wicri:regionArea><wicri:noRegion>Goyang</wicri:noRegion></affiliation></author><author><name sortKey="Ryu, Gi Hyeong" sort="Ryu, Gi Hyeong" uniqKey="Ryu G" first="Gi Hyeong" last="Ryu">Gi Hyeong Ryu</name><affiliation wicri:level="1"><nlm:aff id="A1">Department of Physical Medicine & Rehabilitation, Dongguk University College of Medicine, Goyang, Korea.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Corée du Sud</country><wicri:regionArea>Department of Physical Medicine & Rehabilitation, Dongguk University College of Medicine, Goyang</wicri:regionArea><wicri:noRegion>Goyang</wicri:noRegion></affiliation></author><author><name sortKey="Moon, Heebong" sort="Moon, Heebong" uniqKey="Moon H" first="Heebong" last="Moon">Heebong Moon</name><affiliation wicri:level="1"><nlm:aff id="A1">Department of Physical Medicine & Rehabilitation, Dongguk University College of Medicine, Goyang, Korea.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Corée du Sud</country><wicri:regionArea>Department of Physical Medicine & Rehabilitation, Dongguk University College of Medicine, Goyang</wicri:regionArea><wicri:noRegion>Goyang</wicri:noRegion></affiliation></author><author><name sortKey="Kim, Changjae" sort="Kim, Changjae" uniqKey="Kim C" first="Changjae" last="Kim">Changjae Kim</name><affiliation wicri:level="1"><nlm:aff id="A1">Department of Physical Medicine & Rehabilitation, Dongguk University College of Medicine, Goyang, Korea.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Corée du Sud</country><wicri:regionArea>Department of Physical Medicine & Rehabilitation, Dongguk University College of Medicine, Goyang</wicri:regionArea><wicri:noRegion>Goyang</wicri:noRegion></affiliation></author><author><name sortKey="Nam, Ki Yeon" sort="Nam, Ki Yeon" uniqKey="Nam K" first="Ki Yeon" last="Nam">Ki Yeon Nam</name><affiliation wicri:level="1"><nlm:aff id="A1">Department of Physical Medicine & Rehabilitation, Dongguk University College of Medicine, Goyang, Korea.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Corée du Sud</country><wicri:regionArea>Department of Physical Medicine & Rehabilitation, Dongguk University College of Medicine, Goyang</wicri:regionArea><wicri:noRegion>Goyang</wicri:noRegion></affiliation></author><author><name sortKey="Kwon, Bum 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Medicine, Goyang</wicri:regionArea><wicri:noRegion>Goyang</wicri:noRegion></affiliation></author><author><name sortKey="Lee, Ho Jun" sort="Lee, Ho Jun" uniqKey="Lee H" first="Ho Jun" last="Lee">Ho Jun Lee</name><affiliation wicri:level="1"><nlm:aff id="A1">Department of Physical Medicine & Rehabilitation, Dongguk University College of Medicine, Goyang, Korea.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Corée du Sud</country><wicri:regionArea>Department of Physical Medicine & Rehabilitation, Dongguk University College of Medicine, Goyang</wicri:regionArea><wicri:noRegion>Goyang</wicri:noRegion></affiliation></author><author><name sortKey="Kwon, Jae Hyun" sort="Kwon, Jae Hyun" uniqKey="Kwon J" first="Jae Hyun" last="Kwon">Jae Hyun Kwon</name><affiliation wicri:level="1"><nlm:aff id="A2">Department of Radiology, Dongguk University College of Medicine, Goyang, Korea.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Corée du Sud</country><wicri:regionArea>Department of Radiology, Dongguk University College of Medicine, Goyang</wicri:regionArea><wicri:noRegion>Goyang</wicri:noRegion></affiliation></author><author><name sortKey="Ryu, Gi Hyeong" sort="Ryu, Gi Hyeong" uniqKey="Ryu G" first="Gi Hyeong" last="Ryu">Gi Hyeong Ryu</name><affiliation wicri:level="1"><nlm:aff id="A1">Department of Physical Medicine & Rehabilitation, Dongguk University College of Medicine, Goyang, Korea.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Corée du Sud</country><wicri:regionArea>Department of Physical Medicine & Rehabilitation, Dongguk University College of Medicine, Goyang</wicri:regionArea><wicri:noRegion>Goyang</wicri:noRegion></affiliation></author><author><name sortKey="Moon, Heebong" sort="Moon, Heebong" uniqKey="Moon H" first="Heebong" last="Moon">Heebong Moon</name><affiliation wicri:level="1"><nlm:aff id="A1">Department of Physical Medicine & Rehabilitation, Dongguk University College of Medicine, Goyang, Korea.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Corée du Sud</country><wicri:regionArea>Department of Physical Medicine & Rehabilitation, Dongguk University College of Medicine, Goyang</wicri:regionArea><wicri:noRegion>Goyang</wicri:noRegion></affiliation></author><author><name sortKey="Kim, Changjae" sort="Kim, Changjae" uniqKey="Kim C" first="Changjae" last="Kim">Changjae Kim</name><affiliation wicri:level="1"><nlm:aff id="A1">Department of Physical Medicine & Rehabilitation, Dongguk University College of Medicine, Goyang, Korea.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Corée du Sud</country><wicri:regionArea>Department of Physical Medicine & Rehabilitation, Dongguk University College of Medicine, Goyang</wicri:regionArea><wicri:noRegion>Goyang</wicri:noRegion></affiliation></author><author><name sortKey="Nam, Ki Yeon" sort="Nam, Ki Yeon" uniqKey="Nam K" first="Ki Yeon" last="Nam">Ki Yeon Nam</name><affiliation wicri:level="1"><nlm:aff id="A1">Department of Physical Medicine & Rehabilitation, Dongguk University College of Medicine, Goyang, Korea.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Corée du Sud</country><wicri:regionArea>Department of Physical Medicine & Rehabilitation, Dongguk University College of Medicine, Goyang</wicri:regionArea><wicri:noRegion>Goyang</wicri:noRegion></affiliation></author><author><name sortKey="Kwon, Bum Sun" sort="Kwon, Bum Sun" uniqKey="Kwon B" first="Bum Sun" last="Kwon">Bum Sun Kwon</name><affiliation wicri:level="1"><nlm:aff id="A1">Department of Physical Medicine & Rehabilitation, Dongguk University College of Medicine, Goyang, Korea.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Corée du Sud</country><wicri:regionArea>Department of Physical Medicine & Rehabilitation, Dongguk University College of Medicine, Goyang</wicri:regionArea><wicri:noRegion>Goyang</wicri:noRegion></affiliation></author></analytic><series><title level="j">Annals of Rehabilitation Medicine</title><idno type="ISSN">2234-0645</idno><idno type="eISSN">2234-0653</idno><imprint><date when="2014">2014</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Objective</title><p>To investigate the usefulness of computed tomography venography (CTV) for evaluation of leg swelling, especially deep vein thrombosis (DVT), in rehabilitation patients.</p></sec><sec><title>Methods</title><p>A hundred twenty-three patients, who had performed CTV performed because of suspected DVT in our clinic, were enrolled. We performed chart reviews retrospectively and categorized CTV findings as follows: DVT distal to inguinal ligament and no compression lesion; DVT proximal to inguinal ligament and no compression lesion; DVT distal to inguinal ligament and anatomical variant (for example, May-Thurner syndrome); DVT due to compression of mass (cancer or cyst); DVT and other incidental abnormal finding; and no DVT and other possible causes of leg swelling.</p></sec><sec><title>Results</title><p>DVTs were found in 65 (53%) patients. DVTs were found at distal level (thigh or lower leg) to inguinal ligament in 47 patients. DVTs were found at proximal to inguinal ligament, usually undetectable with duplex ultrasonography, in 6 patients. DVTs caused by external compression, such as femoral vein and cancer mass, were found in 12 patients (10%), which are also not easily detected with duplex ultrasonography. Other various causes of leg edema without DVT were found in 22 (18%) patients.</p></sec><sec><title>Conclusion</title><p>CTV can evaluate more extensively venous problems in the pelvis and abdomen and detect other possible causes of leg swelling. 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<front><journal-meta><journal-id journal-id-type="nlm-ta">Ann Rehabil Med</journal-id><journal-id journal-id-type="iso-abbrev">Ann Rehabil Med</journal-id><journal-id journal-id-type="publisher-id">ARM</journal-id><journal-title-group><journal-title>Annals of Rehabilitation Medicine</journal-title></journal-title-group><issn pub-type="ppub">2234-0645</issn><issn pub-type="epub">2234-0653</issn><publisher><publisher-name>Korean Academy of Rehabilitation Medicine</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">25566481</article-id><article-id pub-id-type="pmc">4280378</article-id><article-id pub-id-type="doi">10.5535/arm.2014.38.6.812</article-id><article-categories><subj-group subj-group-type="heading"><subject>Original Article</subject></subj-group></article-categories><title-group><article-title>Usefulness of the Computed Tomography Venography for Evaluation of Leg Edema Including Deep Vein Thrombosis in Rehabilitation Patients</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Chang</surname><given-names>Ji Hea</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="A1">1</xref></contrib><contrib contrib-type="author" corresp="yes"><name><surname>Lee</surname><given-names>Ho Jun</given-names></name><degrees>MD</degrees><degrees>PhD</degrees><xref ref-type="aff" rid="A1">1</xref></contrib><contrib contrib-type="author"><name><surname>Kwon</surname><given-names>Jae Hyun</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="A2">2</xref></contrib><contrib contrib-type="author"><name><surname>Ryu</surname><given-names>Gi Hyeong</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="A1">1</xref></contrib><contrib contrib-type="author"><name><surname>Moon</surname><given-names>Heebong</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="A1">1</xref></contrib><contrib contrib-type="author"><name><surname>Kim</surname><given-names>Changjae</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="A1">1</xref></contrib><contrib contrib-type="author"><name><surname>Nam</surname><given-names>Ki Yeon</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="A1">1</xref></contrib><contrib contrib-type="author"><name><surname>Kwon</surname><given-names>Bum Sun</given-names></name><degrees>MD</degrees><degrees>PhD</degrees><xref ref-type="aff" rid="A1">1</xref></contrib></contrib-group><aff id="A1"><label>1</label>Department of Physical Medicine & Rehabilitation, Dongguk University College of Medicine, Goyang, Korea.</aff><aff id="A2"><label>2</label>Department of Radiology, Dongguk University College of Medicine, Goyang, Korea.</aff><author-notes><corresp>Corresponding author: Ho Jun Lee. Department of Physical Medicine & Rehabilitation, Dongguk University College of Medicine, 27 Dongguk-ro, Ilsandong-gu, Goyang 410-773, Korea. Tel: +82-31-961-7487, Fax: +82-31-961-7488, <email>hjrhee1@dumc.or.kr</email></corresp></author-notes><pub-date pub-type="ppub"><month>12</month><year>2014</year></pub-date><pub-date pub-type="epub"><day>24</day><month>12</month><year>2014</year></pub-date><volume>38</volume><issue>6</issue><fpage>812</fpage><lpage>820</lpage><history><date date-type="received"><day>28</day><month>5</month><year>2014</year></date><date date-type="accepted"><day>01</day><month>8</month><year>2014</year></date></history><permissions><copyright-statement>Copyright © 2014 by Korean Academy of Rehabilitation Medicine</copyright-statement><copyright-year>2014</copyright-year><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc/3.0/"><license-p>This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by-nc/3.0/">http://creativecommons.org/licenses/by-nc/3.0/</ext-link>) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p></license></permissions><abstract><sec><title>Objective</title><p>To investigate the usefulness of computed tomography venography (CTV) for evaluation of leg swelling, especially deep vein thrombosis (DVT), in rehabilitation patients.</p></sec><sec><title>Methods</title><p>A hundred twenty-three patients, who had performed CTV performed because of suspected DVT in our clinic, were enrolled. We performed chart reviews retrospectively and categorized CTV findings as follows: DVT distal to inguinal ligament and no compression lesion; DVT proximal to inguinal ligament and no compression lesion; DVT distal to inguinal ligament and anatomical variant (for example, May-Thurner syndrome); DVT due to compression of mass (cancer or cyst); DVT and other incidental abnormal finding; and no DVT and other possible causes of leg swelling.</p></sec><sec><title>Results</title><p>DVTs were found in 65 (53%) patients. DVTs were found at distal level (thigh or lower leg) to inguinal ligament in 47 patients. DVTs were found at proximal to inguinal ligament, usually undetectable with duplex ultrasonography, in 6 patients. DVTs caused by external compression, such as femoral vein and cancer mass, were found in 12 patients (10%), which are also not easily detected with duplex ultrasonography. Other various causes of leg edema without DVT were found in 22 (18%) patients.</p></sec><sec><title>Conclusion</title><p>CTV can evaluate more extensively venous problems in the pelvis and abdomen and detect other possible causes of leg swelling. Therefore, CTV can be a useful tool not only for easy detection of DVT but also for evaluating differential diagnosis of leg edema in rehabilitation patients.</p></sec></abstract><kwd-group><kwd>Computed tomography</kwd><kwd>Edema</kwd><kwd>Venography</kwd><kwd>Venous thrombosis</kwd></kwd-group></article-meta></front><floats-group><fig id="F1" orientation="portrait" position="float"><label>Fig. 1</label><caption><p>The computed tomography venography reveals low signal intensity lesion, which means deep vein thrombosis (DVT), inside of right iliac vein (arrowhead) (A) and the well enhancing mass lesions at right lower abdomen (white arrow) compress right external iliac vein (arrowhead) proximal to DVT lesion (B).</p></caption><graphic xlink:href="arm-38-812-g001"></graphic></fig><fig id="F2" orientation="portrait" position="float"><label>Fig. 2</label><caption><p>This image shows low density 2.8×2.9×2.1 cm sized mass lesion (white arrow) in posterolateral area to right common femoral vein (arrowhead) in axial view (A) and the mass (white arrow) compresses right common femoral vein (arrowhead) in coronal view (B).</p></caption><graphic xlink:href="arm-38-812-g002"></graphic></fig><fig id="F3" orientation="portrait" position="float"><label>Fig. 3</label><caption><p>The graph shows distributions of risk factors of VTE among four groups: DVT (+) distal, DVT distal to inguinal ligament; DVT (+) proximal, DVT proximal to inguinal ligament (in abdomen/pelvis) or with compression of other structures; DVT (-), no DVT detected; and DVT (-) other causes, no DVT and other causes of leg swelling detected). The relative proportion of LE paralysis in DVT (-) and DVT (-) with other cause groups was higher, similar to DVT (+) group. Therefore in the patients with LE paralysis usually present in the department of rehabilitation there are various causes of leg swelling and some causes can be found more easily by computed tomography venography than other study. DTV, deep vein thrombosis; VTE, venous thromboembolism; LE, lower extremity.</p></caption><graphic xlink:href="arm-38-812-g003"></graphic></fig><fig id="F4" orientation="portrait" position="float"><label>Fig. 4</label><caption><p>This graph shows the D-dimer values of four groups. D-dimer values of deep vein thrombosis (DVT) proximal group (groups 2, 3, and 4) were significantly different from those of the other three groups. <sup>*</sup>p<0.05, result from ANOVA with post-hoc analysis.</p></caption><graphic xlink:href="arm-38-812-g004"></graphic></fig><table-wrap id="T1" orientation="portrait" position="float"><label>Table 1</label><caption><p>Classification of CTV findings in patients with DVT</p></caption><graphic xlink:href="arm-38-812-i001"></graphic><table-wrap-foot><fn><p>Values are presented as mean±standard deviation.</p><p>CTV, computed tomography venography; DVT, deep vein thrombosis.</p></fn></table-wrap-foot></table-wrap><table-wrap id="T2" orientation="portrait" position="float"><label>Table 2</label><caption><p>Comparisons of clinical characteristics and risk factors in patients with DVT and without DVT</p></caption><graphic xlink:href="arm-38-812-i002"></graphic><table-wrap-foot><fn><p>Values are presented as mean±standard deviation or number (%).</p><p>DVT, deep vein thrombosis; BMI, body mass index; LE paralysis, lower extremity paralysis including hemiplegia, paraplegia, and tetraplegia; VTE, venous thromboembolism.</p><p><sup>*</sup>p<0.05, significant differences exists between DVT group and no DVT group.</p></fn></table-wrap-foot></table-wrap><table-wrap id="T3" orientation="portrait" position="float"><label>Table 3</label><caption><p>No DVT and other causes of leg edema found in CTV without DVT</p></caption><graphic xlink:href="arm-38-812-i003"></graphic><table-wrap-foot><fn><p>DVT, deep vein thrombosis; CTV, computed tomography venography.</p></fn></table-wrap-foot></table-wrap></floats-group></pmc><affiliations><list><country><li>Corée du Sud</li></country></list><tree><country name="Corée du Sud"><noRegion><name sortKey="Chang, Ji Hea" sort="Chang, Ji Hea" uniqKey="Chang J" first="Ji Hea" last="Chang">Ji Hea Chang</name></noRegion><name sortKey="Kim, Changjae" sort="Kim, Changjae" uniqKey="Kim C" first="Changjae" last="Kim">Changjae Kim</name><name sortKey="Kwon, Bum Sun" sort="Kwon, Bum Sun" uniqKey="Kwon B" first="Bum Sun" last="Kwon">Bum Sun Kwon</name><name sortKey="Kwon, Jae Hyun" sort="Kwon, Jae Hyun" uniqKey="Kwon J" first="Jae Hyun" last="Kwon">Jae Hyun Kwon</name><name sortKey="Lee, Ho Jun" sort="Lee, Ho Jun" uniqKey="Lee H" first="Ho Jun" last="Lee">Ho Jun Lee</name><name sortKey="Moon, Heebong" sort="Moon, Heebong" uniqKey="Moon H" first="Heebong" last="Moon">Heebong Moon</name><name sortKey="Nam, Ki Yeon" sort="Nam, Ki Yeon" uniqKey="Nam K" first="Ki Yeon" last="Nam">Ki Yeon Nam</name><name sortKey="Ryu, Gi Hyeong" sort="Ryu, Gi Hyeong" uniqKey="Ryu G" first="Gi Hyeong" last="Ryu">Gi Hyeong Ryu</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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