Detection of unsuspected pelvic DVTs on abdominopelvic CT scans: a potentially life-saving diagnosis

Venous thromboembolism (VTE) is a serious common disorder with substantial cost and morbidity to society and can be life threatening in some cases. The majority of VTE is diagnosed on lower extremity ultrasound or CT pulmonary angiography, but some cases of deep venous thrombosis (DVT) may be occasionally diagnosed on CT of the abdomen and pelvis by the alert radiologist. The purpose of our study was to determine the fraction of new/unsuspected DVTs diagnosed on CTAP and the subsequent management and clinical course of these patients. After Institutional Review Board approval, a retrospective search of an institutional imaging database was performed for all cases of DVTs diagnosed on CTs of the abdomen and pelvis. Patients with positive studies were further investigated via clinical chart review for their subsequent management and clinical course. The 90-day mortality of the patients diagnosed with DVT on CTAP was also recorded. Sixty-two patients met the criteria for positive DVT on CTAP. Of these 62 cases, 26 (42 %) were new. Management was substantially changed in 24 out of 26 cases (92 %), most commonly initiation of anticoagulation. The 90-day mortality rate of patients diagnosed with pelvic DVTs on CTAP in our cohort was 21 %. Timely detection of pelvic DVTs can have serious implications for patient management, morbidity, and mortality. The pelvic veins should be included in the search pattern of all radiologists who review CTs of the abdomen and pelvis.