• Images in cardiology

A 63 year old man was admitted with progressive right lower limb swelling four days after undergoing diagnostic coronary angiography. The procedure was uneventful and showed only minor coronary artery disease. Physical examination showed diffuse bruising over the right groin and swelling of the right lower limb up the thigh. Sonography showed diffuse haematoma over the right groin with no evidence of deep vein thrombosis (DVT). Contrast enhanced computed tomographic (CT) venography with three dimensional reconstruction was performed which revealed the presence of a cresentic thrombus in the proximal part of the right femoral vein with extension into the right superficial femoral vein (arrow).

DVT and fatal pulmonary embolism is a rare but known complication following cardiac catheterisation. It is likely that this patient developed DVT as a consequence of extrinsic compression of the right femoral vein by the haematoma. The presence of haematoma over the soft tissue might lead to a difficulty in identifying the presence of DVT by sonography.

DVT is a common and potentially fatal disease. However, an accurate diagnosis of DVT remains challenging in a significant proportion of patients because of the limitations of conventional non-invasive imaging techniques. The development of helical CT pulmonary angiography and delayed venous imaging (CT venography) has provided a single diagnostic tool that can be used for complete evaluation of thromboembolic disease. As this case shows, CT venography is useful for diagnosing DVT in the event of a negative sonographic result when clinical suspicion is still high.

Three dimensional reconstruction of contrast enhanced delayed CT venography of the pelvis and thigh. The right femoral vein is completely filled with clot (arrow) with extension into the superficial femoral vein. The vein appears enlarged in comparison with the right side and there is enhancement of the wall, suggesting perivenous oedema.