AbuRahma A F, Saiedy S, Robinson P A, Boland J P, Cottrell D J, Stuart C
Department of Surgery, Robert C. Byrd Health Sciences Center, West Virginia University, Charleston Area Medical Center, USA.
Surgery. 1997 Apr;121(4):366-71. doi: 10.1016/s0039-6060(97)90305-6.
Although a fever of unknown origin (FUO) is most often due to other causes, the few caused by pulmonary emboli, pelvic thrombophlebitis, or lower extremity venous thrombosis (DVT) present a diagnostic challenge. The purpose of this study was to evaluate the role of venous duplex imaging of the lower extremity in evaluating a large series of patients with FUO. This has not been reported previously in the English-language literature.
Medical records were analyzed of patients with FUO who were referred to the vascular laboratory for venous duplex imaging of the lower extremities to rule out DVT as a cause of their fever. A FUO was defined as a temperature of greater than 38.3 degrees C on several occasions for at least 3 weeks' duration that defied 1 week of hospital evaluation. DVT was considered as a probable cause of FUO if the following criteria were met: (1) a positive venous duplex image for acute DVT, (2) subsequent fever resolution within 7 days of anticoagulation therapy, and (3) a fever that was resistant to prior treatment.
A total of 114 duplex examinations, gathered during a 2-year period, were analyzed. The 89 patients had a mean age of 58 years. Infections were the most common cause of FUO (57 of 89, 64%), and unknown causes constituted 19%. There were seven cases of DVT (8%), five (6%) of whom met the criteria for probable cause of FUO. The overall cost of venous duplex imaging examinations was $51,300 ($450 x 114 tests), with an average cost of $10,260 for each case of DVT detected as probable cause of FUO.
Consistent with the literature, infections remain the most common cause of FUO; however, DVT was found to be a more common cause of FUO in our present series (6%). The cost of venous duplex imaging of the lower extremities in establishing DVT as a probable cause of FUO should be borne in mind when the work-up of these patients is planned.
尽管不明原因发热（FUO）大多由其他原因引起，但由肺栓塞、盆腔血栓性静脉炎或下肢静脉血栓形成（DVT）导致的少数病例存在诊断挑战。本研究的目的是评估下肢静脉双功成像在评估大量FUO患者中的作用。此前英文文献中尚未有过相关报道。
分析因FUO被转诊至血管实验室进行下肢静脉双功成像以排除DVT作为发热原因的患者的病历。FUO定义为多次体温高于38.3摄氏度，持续至少3周，且经过1周的住院评估仍无法确诊。如果满足以下标准，则DVT被视为FUO的可能原因：（1）急性DVT的静脉双功成像呈阳性；（2）抗凝治疗7天内发热消退；（3）先前治疗无效的发热。
共分析了2年期间收集的114次双功检查。89例患者的平均年龄为58岁。感染是FUO最常见的原因（89例中的57例，64%），不明原因占19%。有7例DVT（8%），其中5例（6%）符合FUO可能原因的标准。静脉双功成像检查的总费用为51,300美元（450美元×114次检查），每例被检测为FUO可能原因的DVT平均费用为10,260美元。
与文献一致，感染仍然是FUO最常见的原因；然而，在我们目前的系列研究中，DVT被发现是FUO更常见的原因（6%）。在规划这些患者的检查时，应考虑下肢静脉双功成像在确定DVT为FUO可能原因时的成本。
