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Combined CT Venography and Pulmonary Angiography in Suspected Thromboembolic Disease

Diagnostic Accuracy for Deep Venous Evaluation

Peter A. Loud1, Douglas S. Katz2, Donald L. Klippenstein1, Rakesh D. Shah2 and Zachary D. Grossman1

1 Department of Radiology, Roswell Park Cancer Institute, Elm and Carlton Sts., Buffalo, NY 14263.
2 Department of Radiology, Winthrop University Hospital, 259 First St., Mineola, NY 11501.



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  		Fig. 1. —31-year-old woman with chest pain and suspected pulmonary embolism. CT pulmonary angiography (not shown) failed to show abnormalities of pulmonary arteries.

A, CT venous phase scan at knee level shows uniform opacification of normal popliteal veins (arrows).

 


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  		Fig. 1. —31-year-old woman with chest pain and suspected pulmonary embolism. CT pulmonary angiography (not shown) failed to show abnormalities of pulmonary arteries.

B, CT scan at inguinal level shows normal common femoral veins (arrows).

 


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  		C, CT scan at upper abdominal level shows normal inferior vena cava (arrow).

 


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  		Fig. 2. —70-year-old woman with pulmonary embolism and bilateral deep venous thrombosis.

A, Helical CT scan at mid chest shows acute emboli as filling defects in right upper lobe and left lower lobe pulmonary arteries (arrows).

 


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  		Fig. 2. —70-year-old woman with pulmonary embolism and bilateral deep venous thrombosis.

B, CT scan at knee level shows deep vein thrombosis as nonenhancing areas in both popliteal veins (arrows).

 


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  		Fig. 2. —70-year-old woman with pulmonary embolism and bilateral deep venous thrombosis.

C, CT scan at inguinal level shows thrombi within both common femoral veins (arrows).

 


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  		Fig. 3. —53-year-old woman with pulmonary embolism and isolated inferior vena cava thrombosis. CT pulmonary angiography (not shown) showed bilateral pulmonary emboli. CT venography and venous sonography (not shown) failed to show abnormalities of leg veins.

A, CT scan at renal vein level shows large thrombus within inferior vena cava (arrow).

 


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  		Fig. 3. —53-year-old woman with pulmonary embolism and isolated inferior vena cava thrombosis. CT pulmonary angiography (not shown) showed bilateral pulmonary emboli. CT venography and venous sonography (not shown) failed to show abnormalities of leg veins.

B, Inferior venacavogram performed before suprarenal caval filter placement confirms presence of caval thrombus (arrows). (Reprinted from [1])

 


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  		Fig. 4. —69-year-old man with deep venous thrombosis extending into pelvis. CT pulmonary angiography (not shown) failed to show abnormalities.

C, CT scan at lower pelvic level shows thrombus in right external iliac vein (arrow).

 


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  		Fig. 4. —69-year-old man with deep venous thrombosis extending into pelvis. CT pulmonary angiography (not shown) failed to show abnormalities.

B, CT scan at inguinal level shows thrombus in right common femoral vein (arrow).

 


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  		Fig. 4. —69-year-old man with deep venous thrombosis extending into pelvis. CT pulmonary angiography (not shown) failed to show abnormalities.

A, CT venous image at mid thigh level shows nonenhancing thrombi within duplicated right femoral veins (straight arrows) and right greater saphenous vein (curved arrow). Duplicated left femoral veins enhance normally (arrowheads).

 

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