CT lower extremity venography in suspected pulmonary embolism in the ED

The purpose of this study was to evaluate the added benefit of computed tomography lower extremity venography (CTLV)--performed following CT pulmonary angiography (CTPA)--in the emergency department (ED) patient suspected of pulmonary embolism (PE). A retrospective review of 427 consecutive patients having both CTPA and CTLV performed to evaluate patients suspected of PE at two community hospitals was conducted. Three-month follow-up was performed on all patients to ensure that no case of PE or deep venous thrombosis (DVT) was missed. Forty patients were positive for PE, and 11 were positive for DVT. There were 6 CTPA studies read as indeterminate for PE and 11 CTLV studies indeterminate for DVT. Only 1 patient was positive for DVT, who did not have a concurrent PE identified by CTPA. The estimated charges for detecting the single case of isolated DVT was 206,400 US dollars. In our ED setting, the additional benefit of adding CTLV to the standard ED work-up of PE was minimal.