ACR appropriateness criteria® suspected upper extremity deep vein thrombosis

Benoit Desjardins, Frank J. Rybicki, Hyun S. Kim, Chieh Min Fan, Scott D. Flamm, Marie D. Gerhard-Herman, Sanjeeva P. Kalva, Scott A. Koss, M. Ashraf Mansour, Emile R. Mohler, Vamsi R. Narra, Matthew P. Schenker, Mark Tulchinsky, Clifford Weiss

Research output: Contribution to journalArticle

Abstract

Upper-extremity venous thrombosis often presents as unilateral arm swelling. The differential diagnosis includes lesions compressing the veins and causing a functional venous obstruction, venous stenosis, an infection causing edema, obstruction of previously functioning lymphatics, or the absence of sufficient lymphatic channels to ensure effective drainage. The following recommendations are made with the understanding that venous disease, specifically venous thrombosis, is the primary diagnosis to be excluded or confirmed in a patient presenting with unilateral upper-extremity swelling. Contrast venography remains the best reference-standard diagnostic test for suspected upper-extremity acute venous thrombosis and may be needed whenever other noninvasive strategies fail to adequately image the upper-extremity veins. Duplex, color flow, and compression ultrasound have also established a clear role in evaluation of the more peripheral veins that are accessible to sonography. Gadolinium contrast-enhanced MRI is routinely used to evaluate the status of the central veins. Delayed CT venography can often be used to confirm or exclude more central vein venous thrombi, although substantial contrast loads are required. The ACR Appropriateness Criteria® are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.

Original languageEnglish (US)
Pages (from-to)613-619
Number of pages7
JournalJournal of the American College of Radiology
Volume9
Issue number9
DOIs
StatePublished - 2012

Fingerprint

Upper Extremity Deep Vein Thrombosis
Veins
Upper Extremity
Venous Thrombosis
Phlebography
Guidelines
Gadolinium
Expert Testimony
Routine Diagnostic Tests
Drainage
Ultrasonography
Edema
Pathologic Constriction
Thrombosis
Arm
Differential Diagnosis
Color
Therapeutics
Infection

Keywords

  • appropriateness criteria
  • computed tomography
  • magnetic resonance imaging
  • ultrasound
  • Upper-extremity deep vein thrombosis
  • venography

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Desjardins, B., Rybicki, F. J., Kim, H. S., Fan, C. M., Flamm, S. D., Gerhard-Herman, M. D., ... Weiss, C. (2012). ACR appropriateness criteria® suspected upper extremity deep vein thrombosis. Journal of the American College of Radiology, 9(9), 613-619. https://doi.org/10.1016/j.jacr.2012.05.021

ACR appropriateness criteria® suspected upper extremity deep vein thrombosis. / Desjardins, Benoit; Rybicki, Frank J.; Kim, Hyun S.; Fan, Chieh Min; Flamm, Scott D.; Gerhard-Herman, Marie D.; Kalva, Sanjeeva P.; Koss, Scott A.; Mansour, M. Ashraf; Mohler, Emile R.; Narra, Vamsi R.; Schenker, Matthew P.; Tulchinsky, Mark; Weiss, Clifford.

In: Journal of the American College of Radiology, Vol. 9, No. 9, 2012, p. 613-619.

Research output: Contribution to journalArticle

Desjardins, B, Rybicki, FJ, Kim, HS, Fan, CM, Flamm, SD, Gerhard-Herman, MD, Kalva, SP, Koss, SA, Mansour, MA, Mohler, ER, Narra, VR, Schenker, MP, Tulchinsky, M & Weiss, C 2012, 'ACR appropriateness criteria® suspected upper extremity deep vein thrombosis', Journal of the American College of Radiology, vol. 9, no. 9, pp. 613-619. https://doi.org/10.1016/j.jacr.2012.05.021
Desjardins, Benoit ; Rybicki, Frank J. ; Kim, Hyun S. ; Fan, Chieh Min ; Flamm, Scott D. ; Gerhard-Herman, Marie D. ; Kalva, Sanjeeva P. ; Koss, Scott A. ; Mansour, M. Ashraf ; Mohler, Emile R. ; Narra, Vamsi R. ; Schenker, Matthew P. ; Tulchinsky, Mark ; Weiss, Clifford. / ACR appropriateness criteria® suspected upper extremity deep vein thrombosis. In: Journal of the American College of Radiology. 2012 ; Vol. 9, No. 9. pp. 613-619.
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AU - Gerhard-Herman, Marie D.

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AU - Koss, Scott A.

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AU - Mohler, Emile R.

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