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Review Question - QID 104031

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QID 104031 (Type "104031" in App Search)
A 58-year-old female is recovering from a total knee replacement performed 3 days previously. She develops sudden onset shortness of breath and is complaining of a sharp pain in her chest with inspiration. A D-dimer test returns as positive, and a chest radiograph is performed and appears normal. Spiral CT scan is indeterminate for the presence of a pulmonary embolism. Homan's sign is absent bilaterally. Venous ultrasound is then performed to attempt to identify a deep venous thrombosis. Where is the venous ultrasound most likely to demonstrate the source of the pulmonary embolus in this patient?

Abdominal inferior vena cava

1%

1/78

Great saphenous veins

6%

5/78

Proximal femoral veins

81%

63/78

Posterior tibial veins

10%

8/78

Basilic veins

0%

0/78

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Venous ultrasound in this patient suffering from a pulmonary embolism would most likely reveal a deep venous thrombosis in the proximal femoral veins. The most common source of symptomatic pulmonary emboli is the proximal deep leg veins.

The majority of pulmonary emboli originate from a deep venous thrombosis (DVT) in the lower extremities. The presence or absence of the Homan's sign is unreliable in determining the presence of a DVT due to its relatively low sensitivity and specificity. In a clinical scenario indicative of a possible pulmonary embolism, if a spiral CT scan returns an inconclusive result, then venous ultrasound of the lower extremities should be performed to detect a DVT that may have been responsible for the thromboembolus. Serial venous ultrasounds have a high diagnostic specificity.

Incorrect Answers:
Answer 1: The IVC is not as common of a source for pulmonary emboli as the proximal deep leg veins.
Answer 2: The great saphenous vein is a superficial vein of the lower extremity; pulmoary emboli usually do not originate from superficial veins.
Answer 4: The posterior tibial vein is a deep leg vein of the distal lower extremity; symptomatic pulmonary emboli more commonly originate from the proximal deep venous system.
Answer 5: The basilic vein is a large superficial vein of the upper extremity; it is typically not a source of pulmonary emboli.

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