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Are They Related?

George C. Velmahos, MD, PhD; Konstantinos Spaniolas, MD; Malek Tabbara, MD; Hani H. Abujudeh, MD; Marc de Moya, MD; Alice Gervasini, PhD; Hasan B. Alam, MD

Arch Surg. 2009;144(10):928-932.

Hypothesis  Pulmonary embolism (PE) and deep venous thrombosis (DVT) in trauma are related.

Design  Retrospective review of medical records.

Setting  Academic level I trauma center.

Patients  Trauma patients who underwent computed tomographic pulmonary angiography (CTPA) with computed tomographic venography (CTV) of the pelvic and proximal lower extremity veins over a 3-year period (January 1, 2004, to December 31, 2006) were reviewed. Data on demographics, injury type and severity, imaging findings, hospital length of stay, and mortality were collected.

Main Outcome Measures  Pulmonary embolism and DVT.

Results  Among 247 trauma patients undergoing CTPA/CTV, PE was diagnosed in 46 (19%) and DVT in 18 (7%). Eighteen PEs were central (main or lobar pulmonary arteries), and 28 PEs were peripheral (segmental or subsegmental branches). Pulmonary embolism occurred within the first week of injury in two-thirds of patients. Seven patients with PE (4 femoral, 2 popliteal, and 1 iliac) had DVT. Pulmonary embolism was central in 5 patients and peripheral in 2 patients. No significant differences were noted in any of the examined variables between patients with PE having DVT and those not having DVT.

Conclusions  Few patients with PE have DVT of the pelvic or proximal lower extremity veins. Pulmonary embolism may not originate from these veins, as commonly believed, but instead may occur de novo in the lungs. These findings have implications for thromboprophylaxis and, particularly, the value of vena cava filters.

Author Affiliations: Division of Trauma, Emergency Surgery, and Surgical Critical Care (Drs Velmahos, Spaniolas, Tabbara, de Moya, Gervasini, and Alam) and Department of Emergency Radiology (Dr Abujudeh), Massachusetts General Hospital and Harvard Medical School, Boston.

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