Diagnostic Imaging Pathways - Deep Venous Thrombosis (Arm)
Population Covered By The Guidance
This pathway provides guidance for imaging adult patients with suspected upper limb deep venous thrombosis.
Date reviewed: January 2012
Date of next review: January 2015
Published: January 2012
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|SYMBOL||RRL||EFFECTIVE DOSE RANGE|
|Minimal||< 1 millisieverts|
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Arm Deep Venous Thrombosis
Image 1a, 1b and 1c (Doppler Ultrasound): Images demonstrate thrombus extending from the basilic (Images 1a and 1b) to the subclavian vein (Image 1c).
- Doppler US is the imaging modality of choice for suspected upper extremity deep venous thrombosis
- Venography is now rarely used in the assessment of possible upper limb DVT
- Generally considered the initial imaging test of choice for the investigation of suspected upper extremity deep venous thrombosis
- An assessment of the compressibility of the subclavian, axillary and sometimes the internal jugular, innominate, brachial and basilic veins
- Doppler imaging to assess the characteristics of venous flow
- Sensitivity has been shown to vary from 78% to 100%
- Specificity has varied from 82-100%
- Advantages of Doppler ultrasound over contrast venography
- Less invasive
- More widely available
- Less expensive
- Considered the gold standard investigation for the investigation of upper extremity deep venous thrombosis
- Involves the injection of contrast into the antecubital vein or if this is not possible a more distal vein. Images are taken of the venous system and thrombus is demonstrated as a filling defect
- Is rarely used in clinical practice because
- It can be technically difficult
- It requires the use of a contrast agent which may cause an allergic reaction, nephrotoxicity or a chemical phlebitis
- Like Doppler ultrasonography, venography is operator dependent with more accurate results and better inter-observer and intra-observer agreement with more experienced operators
References are graded from Level I to V according to the Oxford Centre for Evidence-Based Medicine, Levels of Evidence. Download the document
- Baarslag HJ, van Beek EJR, Koopman MMW, Reekers JA. Prospective study of color duplex ultrasonography compared with contrast venography in patients suspected of having deep venous thrombosis of the upper extremities. Ann Intern Med. 2002;136:865-72. (Level II evidence). View the reference
- Knudson GJ, Wiedmeyer DA, Erickson SJ, et al. Color doppler sonographic imaging in the assessment of upper-extremity deep venous thrombosis. AJR Am J Roentgenol. 1990;154:399-403. (Level IV evidence)
- Prandoni P, Polistena P, Bernardi E, et al. Upper-extremity deep vein thrombosis. Risk factors, diagnosis, and complications. Arch Intern Med. 1997;157:57-62. (Level II evidence). View the reference
- Köksoy C, Kuzu A, Kutlay J, et al. The diagnostic value of colour Doppler ultrasound in central venous catheter related thrombosis. Clin Radiol. 1995;50:687-9. (Level III evidence)
- Falk RL, Smith DF. Thrombosis of upper extremity thoracic inlet veins: diagnosis with duplex Doppler sonography. AJR Am J Roentgenol. 1987;149:677-82. (Level IV evidence)
- Baxter GM, Kincaid W, Jeffrey RF, et al. Comparison of colour Doppler ultrasound with venography in the diagnosis of axillary and subclavian vein thrombosis. Br J Radiol. 1991;64:777-81. (Level II evidence). View the reference
- Haire WD, Lynch TG, Lund GB, et al. Limitations of magnetic resonance imaging and ultrasound-directed (duplex) scanning in the diagnosis of subclavian vein thrombosis. J Vasc Surg. 1991;13:391-7. (Level III evidence)
- Joffe HV, Goldhaber SZ. Upper-extremity deep vein thrombosis. Circulation. 2002;106:1874-80. (Review article)
- Baarslag HJ, van Beek EJR, Tijssen JGP. Deep vein thrombosis of the upper extremity: intra- and interobserver study of digital subtraction venography. Eur Radiol. 2003;13:251-5. (Level II evidence). View the reference
- Mustafa BO, Rathbun SW, Whitsett TL, Raskob GE. Sensitivity and specificity of ultrasonography in the diagnosis of upper extremity deep vein thrombosis. Arch Intern Med. 2002;162:401-4. (Level II evidence). View the reference
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