Souza Frederico F, Otero Hansel J, Erturk Mehmet, Rybicki Frank J, Ramaiya Nikhil, Van den Abbeele Annick D, Di Salvo Donald N
Department of Radiology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
Ultrasound Q. 2009 Sep;25(3):145-50. doi: 10.1097/RUQ.0b013e3181b24f6f.
To examine outpatient oncologic patients with venous thrombosis (VT) and correlate ultrasound findings with clinical characteristics and outcome.
A retrospective study of 76 patients who had upper- and lower-extremity ultrasound examinations positive for VT formed the population, drawn from a total of 509 patients who presented over a 24-month period for non-invasive imaging. Clinical indication, demographics, sonographic findings, comorbidities, and development of pulmonary embolism in these patients were recorded. The Fisher-Freeman-Halton exact test was used to determine if test characteristics varied according to the location of VT (upper or lower extremity), the level of lower-extremity thrombosis (above the knee, below the knee, or both), the presence of active disease or remission, the chronicity or acuteness of thrombosis, and the presence of a central venous catheter (CVC).
In the study group, 64 patients had deep VT, and 12 had superficial VT. The most prevalent tumors in our study population were lymphoma and breast and lung cancers. The most common symptoms were swelling, pain, and erythema. Whereas 61 patients had active disease, 18 patients were in remission at the time of examination. Among 30 patients with upper-extremity VT, 18 had CVCs. Venous thrombosis involved the vessel containing the central venous line in 66% of studies. Pulmonary embolism developed in 8 patients who had lower-extremity VT despite an initiation of anticoagulation therapy. Patients with thrombus in the lower extremity had higher chance to develop pulmonary embolism, but there was no significant statistical difference in the level of lower-extremity thrombosis (above the knee, below the knee, or both), disease activity, and chronicity of thrombosis.
Venous thrombosis is most commonly acute and involves the lower extremity and the deep venous system above the knee. When VT involves the upper extremity, it is usually associated with a CVC. Pulmonary embolism is almost exclusively associated with lower-extremity VT and can occur despite anticoagulation therapy.
研究门诊肿瘤患者静脉血栓形成（VT）情况，并将超声检查结果与临床特征及预后相关联。
对76例上肢和下肢超声检查VT呈阳性的患者进行回顾性研究，这些患者来自24个月内接受非侵入性成像检查的509例患者。记录这些患者的临床指征、人口统计学特征、超声检查结果、合并症以及肺栓塞的发生情况。采用Fisher-Freeman-Halton确切概率法来确定检查特征是否因VT部位（上肢或下肢）、下肢血栓形成水平（膝上、膝下或两者均有）、疾病活动或缓解状态、血栓形成的慢性或急性以及中心静脉导管（CVC）的存在与否而有所不同。
研究组中，64例患者为深静脉VT，12例为浅静脉VT。研究人群中最常见的肿瘤为淋巴瘤、乳腺癌和肺癌。最常见的症状为肿胀、疼痛和红斑。61例患者疾病处于活动期，18例患者在检查时处于缓解期。在30例上肢VT患者中，18例有CVC。66%的研究中静脉血栓累及包含中心静脉导管的血管。8例下肢VT患者在开始抗凝治疗后仍发生了肺栓塞。下肢有血栓的患者发生肺栓塞的几率更高，但下肢血栓形成水平（膝上、膝下或两者均有）、疾病活动度和血栓形成的慢性程度方面无显著统计学差异。
静脉血栓形成最常见为急性，累及下肢及膝上深静脉系统。当VT累及上肢时，通常与CVC相关。肺栓塞几乎仅与下肢VT相关，且即使进行抗凝治疗也可能发生。
