Cellulitis and the prevalence of deep vein thrombosis

Abstract

From February, 1994, to August, 1995, we reviewed the venous duplex ultrasound findings of 207 consecutive patients who presented with clinically evident lower leg cellulitis to determine if thrombophlebitis played a role in this entity. All patients had a recent onset of intense erythema of the lower leg with associated pitting edema and diffuse painful cutaneous or subcutaneous tenderness. One hundred ninety-one patients (92%) had normal venous duplex ultrasound examinations, with no evidence of any acute or chronic disease. Two patients (1%) were found to have an acute deep venous thrombosis isolated to an intramuscular soleal sinus, with no extensions into the tibioperoneal veins or any more proximal disease. Four patients (2%) had superficial thrombophlebitis involving the greater saphenous vein in the lower leg only, and 10 patients (5%) had evidence of chronic obstructive disease with recanalization and post-thrombotic popliteal venous insufficiency. In a subset of 73 patients aged more than 60 years, arterial evaluation with Doppler spectral waveform analysis showed significant obstructive disease in 41 (56%) 17 of the 19 patients with diabetes in this subset (89%) were noted to have positive arterial examinations. These data indicate that when the clinical diagnosis of cellulitis can be made, these is no associated significant acute deep venous thrombosis, and venous duplex ultrasound testing is not indicated. In older patients, particularly patients with diabetes, arterial testing for obstructive disease appears to be most appropriate.