Ultrasonographic examination for deep vein thrombosis (DVT) appears to be a safe diagnostic method, but there has been theoretical concern for dislodgment of the thrombi during ultrasonographic assessment, leading into pulmonary embolism (PE).(1) We conducted a systematic review of the literature for reports of possible or confirmed PE as a consequence of ultrasonographic assessment of the extremities for venous thrombosis.

We searched PubMed for studies published from English from January 1960 to April 2015. We also searched the reference lists of retrieved papers for additional relevant publications. We included all cohort studies, case series, and case reports that described PE as a consequence of ultrasonographic assessment of extremities. We excluded studies that reported assessment of areas other than extremities. If there were multiple reports for the same patient(s), only the most comprehensive single reports was considered. We conducted the study in accordance with the Preferred...

We screened 3626 articles, of which 15 reported the issue of clot dislodgement and embolization following ultrasonographic examination of the extremities (Figure 1).(1, 3-16) Of the 8 cases, 7 were male and the age ranged between 21 and 75 years. DVTs were in the lower extremities in all 8 cases; 5 in right and 3 in left lower extremity. In 6 cases the femoral veins were involved, and a free-floating thrombus was reported in 2. Compression ultrasonography was used in all cases, with or without...

Clot dislodgment following ultrasonographic assessment of extremities for DVT can lead into PE and may have fatal outcomes. In our study, all PEs occurred following ultrasound evaluation for lower extremity DVT. Interestingly, we identified multiple reports that claimed to have discussed clot embolization following ultrasonography for the first time (8-12), a finding that speaks of under-recognition of this phenomenon, even among clinicians who had suspected or faced it. Clinicians and radiologists should be cognizant of embolization if a previously visualized clot disappears during ultrasonographic assessment....

1. Raghavendra BN, Horii SC, Hilton S, Subramanyam BR, Rosen RJ, Lam S. Deep venous thrombosis: detection by probe compression of veins. J Ultrasound Med. 1986;5(2):89-95. 2. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. Bmj. 2009;339:b2700. 3. Froggatt DL, Tibbutt DA. Hazard of ultrasonic detection of deep vein thrombosis. Br Med J. 1973;1(5853):614. 4....