Department of Ultrasound, Beijing Hospital of Ministry of Health, Beijing 100730, China.
Chin Med J (Engl). 2013 Dec;126(23):4448-52.
Differential diagnosis of isolated calf muscle vein thrombosis (ICMVT) and gastrocnemius hematoma is essential for early identification of deep vein thrombosis (DVT). This study aimed to investigate the diagnostic value of high-frequency color Doppler ultrasound for differential diagnosis of ICMVT and gastrocnemius hematoma.
A retrospective case series of 35 ICMVT (M:F, 21:14; mean age (64.5 ± 10.6) years) and 23 gastrocnemius hematoma (M:F, 16:7; mean age (75.4 ± 11.8) years) patients with bilateral/unilateral lower limb pain was conducted between January 2006 and September 2012. Characteristics and the morphology of high-frequency color Doppler ultrasonography of the lower limb deep vein, great saphenous vein, calf muscles, skin, and soft tissue were examined.
ICMVT hypoechoic signals were characterized by long, tube-like masses on longitudinal sections and oval masses on transverse sections, with apparent muscle thrombosis boundaries, distal and proximal venous connections, and, often, lower limb DVT. Gastrocnemius hematoma hypoechoic signals were characterized by large volumes, enhanced posterior hematoma echo, hyperechoic muscle boundaries, no hematoma blood flow, and no DVT, and clear differences in trauma/exercise- and oral anticoagulant-induced hematomas were readily apparent. According to the measurement, the ratio of long diameter/transverse diameter (D/T) in ICMVT patients was about less than 2.0, whereas in gastrocnemius hematoma patients the ratio was more than 2.0. Early stage isoechoic and hypoechoic signals were detected with gradually increasing ovular anechoic areas. Partial muscle fibers in the hematoma due to muscle fractures were apparent.
High-frequency color Doppler ultrasound was found to be a sensitive and reliable method for differential diagnosis of ICMVT and gastrocnemius hematoma due to trauma and exercise or prolonged oral anticoagulant use.
孤立性小腿肌肉静脉血栓形成（ICMVT）和比目鱼肌血肿的鉴别诊断对于早期识别深静脉血栓形成（DVT）至关重要。本研究旨在探讨高频彩色多普勒超声对 ICMVT 和比目鱼肌血肿的鉴别诊断价值。
回顾性分析了 2006 年 1 月至 2012 年 9 月期间因双侧/单侧下肢疼痛而就诊的 35 例 ICMVT（男/女 21/14；平均年龄 64.5±10.6 岁）和 23 例比目鱼肌血肿（男/女 16/7；平均年龄 75.4±11.8 岁）患者的病例资料。检查下肢深静脉、大隐静脉、小腿肌肉、皮肤和软组织的高频彩色多普勒超声特征和形态。
ICMVT 的低回声信号在纵切面表现为长管状肿块，在横切面表现为椭圆形肿块，肌肉血栓边界明显，远近端静脉相通，常伴有下肢 DVT。比目鱼肌血肿的低回声信号特征为体积较大，后血肿回声增强，肌肉边界高回声，无血肿血流，无 DVT，外伤/运动或长期口服抗凝引起的血肿之间差异明显。根据测量，ICMVT 患者的长径/横径（D/T）比值小于 2.0，而比目鱼肌血肿患者的比值大于 2.0。早期等回声和低回声信号逐渐出现椭圆形无回声区。血肿中有部分肌纤维因肌肉骨折而明显。
高频彩色多普勒超声是一种敏感、可靠的方法，可用于鉴别诊断创伤和运动或长期口服抗凝引起的 ICMVT 和比目鱼肌血肿。
