A new protocol for diagnosis and treatment

In this issue Cogo and others from Italy, Canada, and the Netherlands describe using two ultrasound examinations a week apart in 1702 outpatients with suspected deep vein thrombosis of the leg to determine whom to treat (p 17).1 Four hundred and twelve were diagnosed with thrombosis by this procedure; the rest were observed without treatment for six months. Nine of the untreated patients developed proof of thromboembolic disease during follow up: two had pulmonary embolism, fatal in one. Overall, fewer than 1% of patients presenting with possible deep vein thrombosis were missed with the authors' approach and only one (<0.1% of patients enrolled) paid with his life. Is the authors' protocol now ready for routine use? Is this the requiem for the venogram?

The protocol was straightforward. The authors used the least expensive type of ultrasound imaging: grey scale real time ultrasound. Doppler signals, manoeuvres to change venous flow, and colour were not used. While Doppler and colour technology are essential for measuring valvular regurgitation echocardiographically and …