Venous Thrombosis in an Outpatient Oncologic Center Distribution, Type, and Comorbidities Frederico F. Souza, MD,*Þ Hansel J. Otero, MD,*Þ Mehmet Erturk, MD,Þ Frank J. Rybicki, MD, PhD,Þ Nikhil Ramaiya, MD,* Annick D. Van den Abbeele, MD,* and Donald N. Di Salvo, MD*Þ Purpose: To examine outpatient oncologic patients with venous thrombosis (VT) and correlate ultrasound findings with clinical char- acteristics and outcome. Materials and Methods: A retrospective study of 76 patients who had upper- and lower-extremity ultrasound examinations positive for VT formed the population, drawn from a total of 509 patients who presented over a 24-month period for non-invasive imaging. Clinical indication, demographics, sonographic findings, comorbidities, and development of pulmonary embolism in these patients were recorded. The Fisher-Freeman-Halton exact test was used to determine if test characteristics varied according to the location of VT (upper or lower extremity), the level of lower-extremity thrombosis (above the knee, below the knee, or both), the presence of active disease or remission, the chronicity or acuteness of thrombosis, and the presence of a cen- tral venous catheter (CVC). Results: In the study group, 64 patients had deep VT, and 12 had superficial VT. The most prevalent tumors in our study population were lymphoma and breast and lung cancers. The most common symptoms were swelling, pain, and erythema. Whereas 61 patients had active disease, 18 patients were in remission at the time of examination. Among 30 patients with upper-extremity VT, 18 had CVCs. Venous thrombosis involved the vessel containing the central venous line in 66% of studies. Pulmonary embolism developed in 8 patients who had lower-extremity VT despite an initiation of anti- coagulation therapy. Patients with thrombus in the lower extremity had higher chance to develop pulmonary embolism, but there was no significant statistical difference in the level of lower-extremity thrombosis (above the knee, below the knee, or both), disease activity, and chronicity of thrombosis. Conclusions: Venous thrombosis is most commonly acute and in- volves the lower extremity and the deep venous system above the knee. When VT involves the upper extremity, it is usually associated with a CVC. Pulmonary embolism is almost exclusively associated with lower-extremity VT and can occur despite anticoagulation therapy. Key Words: venous thrombosis, pulmonary embolism, central venous catheter, DVT, superficial venous thrombosis (Ultrasound Quarterly 2009;25:145Y150) LEARNING OBJECTIVES After participating in this educational activity, the parti- cipant should be better able to: 1. Point out the most common clinical indications, scanning protocols, and ultrasonographic findings of venous thrombosis in cancer patients. 2. Describe the type of tumor, anatomical distribution of clot, and potential for pulmonary embolism of venous thrombosis in cancer patients. 3. Identify predisposing factors that may lead to venous thrombosis in cancer patients. V enous thrombosis is a common complication in patients with cancer and is an important cause of mortality and morbidity. 1 Patients with cancer are at an increased risk of development of thrombotic episodes, and venous thrombosis can be the first sign of an occult malignancy. Previous reports have demonstrated an incidence of venous thrombosis varying 2 between 11% and 25%. In addition, when cancer is diagnosed within 1 year after an episode of venous thrombosis, the likelihood of metastatic disease is greatly increased, and the survival rate at 1 year is greatly reduced. 1,3 The risk of venous thrombosis varies according to different tumor types and is thought to be higher in patients with ovarian, pancreatic, and central nervous system neo- plasms. 1 Many factors are known to contribute to the risk of venous thrombosis, including primary tumor site, chemother- apy, and the presence of indwelling central venous catheters (CVCs). 1,3 The purpose of this study was to evaluate the indication, primary diagnosis, and outcomes of upper- and lower-extremity venous sonographic examinations in patients ORIGINAL RESEARCH CME ARTICLE Ultrasound Quarterly & Volume 25, Number 3, September 2009 www.ultrasound-quarterly.com 145 Received for publication January 5, 2009; accepted April 20, 2009. *Clinical Fellow in Oncoradiology (Souza), Research Fellow (Otero), MRI Di- rector (Ramaiya), Directory of Radiology Department (Van den Abbeele), Director of Ultrasound Section (Di Salvo), Department of Radiology, Dana- Farber Cancer Institute; and †Clinical Fellow in Oncoradiology (Souza), Research Fellow (Otero), Radiologist (Erturk), Director of Cardiovascular Radiology (Rybicki), Director of Ultrasound Services (Di Salvo), Depart- ment of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA. Dr Rybicki has disclosed that he was/is a recipient of grant/research funds from Toshiba, Siemens, and Bracco; and was/is on the speakers’ bureau of Toshiba, Siemens, and Bracco. Dr Van den Abbeele has disclosed that she was/is a recipient of grant/research funds from Pfizer and Novartis. The remaining authors have disclosed that they have no interests in or significant relationships with any commercial companies pertaining to this educational activity. All staff in a position to control the content of this CME activity have disclosed that they have no financial relationships with, or financial interests in, any commercial companies pertaining to this educational activity. Lippincott CME Institute, Inc, has identified and resolved all faculty and staff conflicts of interest regarding this educational activity. Reprints: Frederico F. Souza, MD, Department of Radiology, Dana-Farber Cancer Institute, 44 Binney St, Boston, MA 02115 (e-mail: ffsouza@ partners.org). Copyright * 2009 by Lippincott Williams & Wilkins 9 Copyright @ 200 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.