The Incidental Findings of Venous Duplex Examinations: A Look at Their Aftermath
Michael F. Amendola, MD1, Kyeong Ri Yu, BS2.
1VA Medical Center/VCU Health System, Richmond, VA, USA, 2VCU School of Medicine, Richmond, VA, USA.
Deep vein thrombosis of the lower extremity annually affects about 250,000 individuals in the United States. Previous study has indicated that 11% of patients who were referred for DVT were found to have non-thrombotic causes on their duplex exams. Our goal was to examine the outcomes of non-thrombotic incidental findings encountered in lower extremity deep venous exams.
We retrospectively queried our vascular duplex database from January 1, 2018 to June 30, 2018 to identify all patients who have undergone upper and/or lower extremity venous duplex, excluding directed studies for venous reflux evaluation. We followed outcomes until July 20, 2018. All exams were searched for the following incidental findings: Bakerís cysts, arterial aneurysm, muscle tears with hematoma, lymph nodes, and/or mass. The clinical indications such as cellulitis, edema, and/or pain, as well as patient outcomes such as time to referral to specialist and management were recorded.
Over the six-month period there were a total of 3341 studies undertaken, of which 950 (29%) were evaluation of the venous system. A total of 11% of the studies (n=105) had incidental findings. Venous reflux was found incidentally in 13.7% (n = 161) of all venous duplex examinations. Among all exams with incidental findings, Bakerís cysts occurred in 46.7% (n=49), arterial aneurysm in 3.8% (n=4), muscle tears with hematoma in 12.3% (n=13), lymph nodes in 31.4% (n=33) and mass in 5.7% (n=6) of the studies. Of the forty-nine Bakerís cysts, 26.5% were referred to Orthopedic Surgery, of which only seven had either injection, aspiration, and/or operative management. All cases of muscle tears, barring two who were lost to follow up, were managed conservatively through antibiotics, monitoring, and/or reduction of anticoagulation. The work up of the lymph nodes and/or mass revealed the following pathologies: one lymphoma, one peripheral nerve sheath tumor, and one enlarging lymph node.
We found an incidental finding rate of 11%. The most common of these were Bakerís cysts, of which only about a quarter received any treatment. Our data supports screening for venous reflux in these studies to uncover a significant number of patients with this disease state.
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