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ABSTRACT: Compression ultrasonography of the lower extremity is an established method of detecting proximal lower extremity deep venous thrombosis when performed by a certified operator in a vascular laboratory. Our objective is to determine the sensitivity and specificity of bedside 2-point compression ultrasonography performed in the emergency department (ED) with portable vascular ultrasonography for the detection of proximal lower extremity deep venous thrombosis. We did this by directly comparing emergency physician-performed ultrasonography to lower extremity duplex ultrasonography performed by the Department of Radiology.
This was a prospective, cross-sectional study and diagnostic test assessment of a convenience sample of ED patients with a suspected lower extremity deep venous thrombosis, conducted at a single-center, urban, academic ED. All physicians had a 10-minute training session before enrolling patients. ED compression ultrasonography occurred before Department of Radiology ultrasonography and involved identification of 2 specific points: the common femoral and popliteal vessels, with subsequent compression of the common femoral and popliteal veins. The study result was considered positive for proximal lower extremity deep venous thrombosis if either vein was incompressible or a thrombus was visualized. Sensitivity and specificity were calculated with the final radiologist interpretation of the Department of Radiology ultrasonography as the criterion standard.
A total of 47 physicians performed 199 2-point compression ultrasonographic examinations in the ED. Median number of examinations per physician was 2 (range 1 to 29 examinations; interquartile range 1 to 5 examinations). There were 45 proximal lower extremity deep venous thromboses observed on Department of Radiology evaluation, all correctly identified by ED 2-point compression ultrasonography. The 153 patients without proximal lower extremity deep venous thrombosis all had a negative ED compression ultrasonographic result. One patient with a negative Department of Radiology ultrasonographic result was found to have decreased compression of the popliteal vein on ED compression ultrasonography, giving a single false-positive result, yet repeated ultrasonography by the Department of Radiology 1 week later showed a popliteal deep venous thrombosis. The sensitivity and specificity of ED 2-point compression ultrasonography for deep venous thrombosis were 100% (95% confidence interval 92% to 100%) and 99% (95% confidence interval 96% to 100%), respectively.
Emergency physician-performed 2-point compression ultrasonography of the lower extremity with a portable vascular ultrasonographic machine, conducted in the ED by this physician group and in this patient sample, accurately identified the presence and absence of proximal lower extremity deep venous thrombosis.
Annals of emergency medicine 12/2010; 56(6):601-10. DOI:10.1016/j.annemergmed.2010.07.010 · 4.33 Impact Factor
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ABSTRACT: BACKGROUND: Giant hydronephrosis is a relatively rare condition caused by obstruction of the renal collecting system that can present with a great number of different types of abdominal signs and symptoms. CASE REPORT: A 40-year-old man without past medical history presented to the Emergency Department with diffuse abdominal pain, nausea, and vomiting. On examination, he was found to have an acute abdomen. Computed tomography scan revealed left giant hydronephrosis secondary to an obstructing renal calculus. The patient had a left percutaneous nephrostomy tube placed, which drained over 7 L of fluid from the dilatated collecting system. CONCLUSION: Giant hydronephrosis is a rare potential cause of abdominal pain, particularly in the context of a patient with known nephrolithiasis, structural urologic abnormalities, or malignancy.
Journal of Emergency Medicine 10/2010; 43(5). DOI:10.1016/j.jemermed.2010.07.021 · 1.18 Impact Factor
Journal of Emergency Medicine 10/2007; 33(3):328-328. DOI:10.1016/j.jemermed.2007.08.021 · 1.18 Impact Factor