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Diagnostic methods for deep venous thrombosis.

The article by Foti and Gurewich entitled "Fibrin Degradation Products and Impedance Plethysmography: Measurements in the Diagnosis of Acute Deep Vein Thrombosis" (see p 903) addresses an important and common clinical problem—the noninvasive diagnosis of clinically suspected deep venous thrombosis. Impedance plethysmography (IPG) using inflation of a pneumatic cuff on the thigh has been shown to have a sensitivity of 96% for phlebographically proven deep venous thrombi (DVT) above the knee, with a very low rate of false-positive interpretations (about 2%), in four studies summarized in the Table. 1-4 Unfortunately, IPG has a sensitivity of only 20% for phlebographically proven DVT confined to the calf. In my experience, the sensitivity for DVT confined to the calf is similar with another noninvasive test, phleborrheography (PRG). 5,6 Since thrombi confined to the calf constitute about one third of the DVT diagnosed by phlebography, normal IPG or PRG does not adequately exclude the diagnosis. One