[Ultrasonography of the leg veins is cost-effective and can be the preferred diagnostic study in suspected pulmonary embolism].

Objective: To determine whether compression ultrasound examination of both legs, to detect deep venous thrombosis, can be the examination of first choice in patients clinically suspected of pulmonary embolism, assuming that the therapy of thrombosis is the same as the therapy of embolism.
Design: Prospective study.
Setting: St. Clara Hospital, Rotterdam, the Netherlands.
Methods: 337 consecutive patients (157 women and 180 men, mean age 65 years, SD: 17.4) suspected of pulmonary embolism underwent compression ultrasound examination of the femoral and popliteal veins to detect deep venous thrombosis, and perfusion lung scintigraphy, with ventilation scintigraphy if indicated. Ultrasound examinations and lung scans were interpreted independently and blinded. A financial analysis of the various strategies was made.
Results: Deep venous thrombosis was demonstrated ultrasonographically in four (2%) of 208 patients with a normal lung scan, in four (9%) of 43 patients with a non-diagnostic lung scan, and in 30 (35%) of 86 patients with a high probability lung scan. By starting the diagnostic investigation with ultrasound examination 38 lung scans and chest X-rays would be saved at the cost of 294 extra ultrasound examinations. Because ultrasound examinations are relatively inexpensive a cost reduction of 3.4% would be realised, for the Netherlands approximately 1.4 million guilders. In the United States, however, costs would increase because of the high prices of ultrasound examinations.
Conclusion: Compression ultrasound examination of both legs can be the examination of first choice in the Netherlands in patients suspected of pulmonary embolism, as it is cost effective.