Stein P D, Henry J W, Gopalakrishnan D, Relyea B
Henry Ford Heart and Vascular Institute, Detroit, MI 48202-2691, USA.
Chest. 1995 Apr;107(4):936-9. doi: 10.1378/chest.107.4.936.
The purpose of this investigation was to evaluate measured asymmetry of the calves in the assessment of patients with suspected pulmonary embolism (PE).
Patients randomized for pulmonary angiography in the collaborative study of the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) were evaluated. Only patients in whom the circumference of the calves was measured were included in this evaluation of PIOPED data. Among these, 232 had angiographically diagnosed PE and 446 had no PE by angiography. For purposes of comparison, measurements of the calves also were made in a nonrandomized current cohort of 101 healthy subjects. All calf measurements were made 10 cm below the tibial tuberosity.
Asymmetry in the circumference of the calves of 1 cm or more was measured in 101 of 232 or 44% (95% confidence interval [CI], 37 to 51%) with PE, 176 of 446 or 39% (95% CI, 34 to 44%) without PE, and in 6 of 101 or 6% (95% CI, 1 to 11%) control subjects (PE vs control subjects, p < 0.001; subjects without PE vs control subjects, p < 0.001; PE vs no PE, p = NS). Among patients with PE, the addition of calf asymmetry of 1 cm or more to qualitative signs of deep venous thrombosis increased the prevalence of a detectable abnormality of the lower extremities from 62 of 232 or 27% (95% CI, 21 to 33%) to 129 of 232 or 56% (95% CI, 49 to 63% [p < 0.001]).
Asymmetry of the calves of 1 cm or more is abnormal. Such asymmetry of the calves did not distinguish between patients with PE and those with no PE. When considered in proper perspective with other nonspecific signs and symptoms in patients with suspected acute PE, however, subtle calf asymmetry may call attention to the possibility of thromboembolic disease. The observation of subtle asymmetry may indicate a need for noninvasive diagnostic tests of the lower extremities to determine whether deep venous thrombosis is present.
本研究旨在评估在疑似肺栓塞（PE）患者评估中测量的小腿不对称情况。
对参与肺栓塞诊断前瞻性研究（PIOPED）协作研究中随机接受肺血管造影的患者进行评估。本项对PIOPED数据的评估仅纳入测量了小腿周长的患者。其中，232例经血管造影诊断为PE，446例经血管造影未发现PE。为作比较，还对101名健康受试者的非随机当前队列进行了小腿测量。所有小腿测量均在胫骨结节下方10厘米处进行。
在232例PE患者中，101例（44%，95%置信区间[CI]，37%至51%）小腿周长不对称达1厘米或以上；在446例无PE患者中，176例（39%，95%CI，34%至44%）小腿周长不对称达1厘米或以上；在101名对照受试者中，6例（6%，95%CI，1%至11%）小腿周长不对称达1厘米或以上（PE患者与对照受试者相比，p<0.001；无PE患者与对照受试者相比，p<0.001；PE患者与无PE患者相比，p=无显著差异）。在PE患者中，将小腿周长不对称1厘米或以上与深静脉血栓形成的定性体征相结合，可使下肢可检测到异常的患病率从232例中的62例（27%，95%CI，21%至33%）增至232例中的129例（56%，95%CI，49%至63%[p<0.001]）。
小腿周长不对称达1厘米或以上为异常情况。这种小腿不对称情况无法区分PE患者和无PE患者。然而，当与疑似急性PE患者的其他非特异性体征和症状综合考虑时，细微的小腿不对称可能提示存在血栓栓塞性疾病的可能性。观察到细微不对称可能表明需要对下肢进行无创诊断检查，以确定是否存在深静脉血栓形成。
