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World J Crit Care Med. Sep 9, 2021; 10(5): 194-203
Published online Sep 9, 2021. doi: 10.5492/wjccm.v10.i5.194
Incremental value of compression ultrasound sonography in the emergency department
Alessandro Di Vilio, Andrea Vergara, Alfonso Desiderio, Franco Iodice, Alessandro Serio, Stefano Palermi, Francesco Gambardella, Simona Sperlongano, Renato Gioia, Maria Acitorio, Antonello D'Andrea
Alessandro Di Vilio, Andrea Vergara, Franco Iodice, Simona Sperlongano, Unit of Cardiology and Intensive Coronary Care, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, Naples 80131, Italy
Alfonso Desiderio, Maria Acitorio, Antonello D'Andrea, Unit of Cardiology and Intensive Coronary Care, Umberto I Hospital, Nocera Inferiore 84014, Italy
Alessandro Serio, Stefano Palermi, Francesco Gambardella, Human Anatomy and Sport Medicine Division, Department of Public Health, University of Naples “Federico II”, Naples 80131, Italy
Renato Gioia, Department of Medicine, Surgery, and Dentistry, University of Salerno, Salerno 84084, Italy
Author contributions: Di Vilio A and D’Andrea A proposed concepts; D’Andrea A, Di Vilio A, and Vergara A conducted methodology; Di Vilio A and Vergara A were responsible for drafting the manuscript; Di Vilio A, D’Andrea A, Vergara A, Iodice F, Desiderio A, Acitorio M, Sperlongano S, Serio A, Palermi S, Gambardella F, and Gioia R performed writing reviews and editing; D’Andrea A, Desiderio A, and Acitorio M performed supervision.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Alessandro Di Vilio, MD, Doctor, Unit of Cardiology and Intensive Coronary Care, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, Via Leonardo Bianchi, Naples 80131, Italy. adivilio56@gmail.com
Received: March 14, 2021
Peer-review started: March 15, 2021
First decision: April 6, 2021
Revised: April 13, 2021
Accepted: July 5, 2021
Article in press: July 5, 2021
Published online: September 9, 2021
Processing time: 178 Days and 16 Hours
Abstract

The quick evaluation of venous thromboembolism is a key point of modern medicine since the delayed diagnosis is associated with a worse prognosis. Venous ultrasound (VU) is a sensitive and rapidly performed test in cases of suspected deep venous thrombosis. Various protocols have been proposed for its execution, such as the study of the whole deep venous circulation of the lower limb or the analysis of the femoral-popliteal area. The aim is to detect a vessel thrombus and the most sensitive element is the non-compressibility with the probe. Initially, the thrombus is hypoechogenic and adherent to the vessel; later, it tends to organize and recanalize. Usually, in the early stages, the risk of embolism is higher. The role of studying the iliac axis and calf veins is still uncertain. VU is not useful for assessing response to anticoagulation therapy and it is unclear whether the persistence of thrombotic abnormalities can guide on a possible prolongation of therapy.

Keywords: Compression ultrasound; Deep venous thrombosis; Venous ultrasound; Venous thromboembolism; Critical care ultrasonography

Core Tip: Venous ultrasound represents an important weapon for emergency setting care. Nevertheless, several different protocols present in the literature could create confusion. In this review our goal is to define a practical and clear guide to support the physician in rapid deep venous thrombosis diagnosis and correct management.