Introduction Both B-mode ultrasound and contrast-enhanced ultrasound (CEUS) are well established procedures when diagnosing traumatic splenic ruptures (TSR). To date, there are no data about CEUS patterns in spontaneous splenic ruptures (SSR). It remains unknown whether TSR and SSR differ with respect to clinical characteristics, B-mode and CEUS characteristics. Patients and Methods Between 12/2003 and 2/2010, n=33 SSRs and n=29 TSRs were diagnosed in a tertiary referral center. All patients were examined with B-mode and CEUS, and clinical data and the outcome were retrospectively analyzed. Results Patients with SSR were significantly older than patients with TSR (62 years vs. 44 years; p=0.01). The 4-week mortality was significantly higher in SSR than in TSR (36% vs. 0%; p=0.001). No differences between the grading of TSR and SSR could be shown in B-mode or in CEUS. Notably, CEUS was significantly superior to B-mode with respect to the grading of splenic ruptures (p=0.01). Therefore, therapeutic management was influenced by CEUS. Conclusion There are differences between SSR and TSR, especially concerning clinical data (age, course of disease and mortality). Regarding the sonographic pattern, SSR and TSR show identical grading. When splenic rupture is suspected, CEUS should always be performed to identify patients at risk who require interventional procedures.

AimTo investigate the value of B-mode imaging and contrast-enhanced ultrasonography (CEUS) in patients with clinically suspected pulmonary embolism (PE) but no evidence of central PE on CT. MethodsBetween May 2004 and February 2015, we included in this retrospective study 19 patients with a risk profile for PE according to their Wells' score, sonographic patterns of peripheral embolic consolidations (EC) on B-mode-imaging and CEUS (ie, missing or inhomogeneous enhancement of the pleural lesions), and exclusion of central PE by CT within 1 week of CEUS. ResultsOn B-mode imaging, 19 pleural defects presented as hypoechoic. The shape of EC was round in 2, wedge-shaped in 12, polygonal in 3, and presented as atelectasis in 2 cases. On CEUS, 5 of the defects demonstrated, at the arterial and parenchymal phase, a lack of enhancement, and 14 showed an inhomogeneous (mixed) enhancement with wedge-shaped peripheral areas of no contrast enhancement. A second radiologic evaluation of the CT scans revealed PE in two patients and lesions suspicious for malignancy in two other patients. ConclusionsDespite the lack of definite confirmation of peripheral and central PE on CT, peripheral pleural consolidations with no or inhomogeneous enhancement on CEUS, in combination with the risk profile for a PE, are highly suggestive of EC. If there is still some doubt, histologic confirmation is important to confirm EC and exclude malignancy. Thus, CEUS may close a potential diagnostic gap of small peripheral PE on CT. (c) 2017 Wiley Periodicals, Inc. J Clin Ultrasound45:575-579, 2017

Mucormycosis is a fungal infection that can potentially manifest in any organ system. It mainly affects immunocompromised patients with diabetes mellitus type II or malignant hematologic diseases, especially after stem cell transplantation 1 2. In a study of 929 patients facing zygomycosis, infestation of the sinus cavities (39%) was observed most frequently, followed by pulmonary (24%) and cutaneous manifestations (19%) 1. However, mucormycosis of the liver and spleen is rare and has been documented only in several case reports 3. Contrast-enhanced ultrasound (CEUS) is an established and important method for the diagnosis of focal liver lesions. The first guidelines for CEUS of the liver were published in 2004, followed by updates in 2008 and 2012 4. CEUS imaging of mucormycosis has not been described in the literature. To our knowledge, this case report describes hepatic and splenic mucormycosis using CEUS for the first time.

Liver lesions of Hodgkin’s lymphoma and other lymphoma types usually appear as hypoechoic lesions in grayscale abdominal ultrasound. Here we describe the unusual case of hyperechoic liver nodules caused by Hodgkin’s lymphoma.

PURPOSEThe aim of the retrospective study is to illustrate the role of contrast-enhanced ultrasound (CEUS) in the dignity assessment of focal liver lesions compared to B-mode ultrasound (US) in patients with malignant haematological diseases (MHD).PATIENTS AND METHODSFocal liver lesions were diagnosed in n = 61 patients (24 female, 37 male) with MHD via US within the period from November 2005 to February 2009. After the presentation of a not clearly cystic liver lesion (n = 48), CEUS was performed and documented in addition to US. The underlying diagnoses were stem cell diseases (n = 31) and malignant lymphomas (n = 30). The detection of a lesion was documented in n = 17 patients with at this time point primary diagnosed haematological disease, n = 13 patients were in relapse and n = 31 in complete remission (CR). The diagnoses of the liver pathology were confirmed through sonographic follow-up studies and clinical courses (n = 22), CT/MRI (n = 18) and histology (n = 21).RESULTSIn total 67 % of the cases were diagnosed as benign and 33 % as malignant liver lesions. Regarding the therapeutic state, the numbers of benign lesions differ from those of malignant lesions: primary diagnosis 53 vs. 47 %, relapse 69 vs. 31 %, CR 90 vs. 10 %. The frequency distributions of benign versus malignant lesions were 94 vs. 6 % in patients with stem cell diseases and 40 vs. 60 % in patients with malignant lymphomas. Regarding dignity assessment of focal liver lesions, CEUS showed a sensitivity of 90 vs. 45 % and specificity of 96 vs. 18 % (p < 0.0001) compared to US.CONCLUSIONCEUS possesses a significant diagnostic value in the characterization of focal liver lesions and should be used in the context of staging procedures in patients with MHD.

Purpose: Description of contrast-enhanced ultrasound (CEUS) patterns of hepatic lymphoma.Materials and Methods: Over a period of 6 years and 1 month from January 2006 to January 2012, n = 38 patients with histological or clinically apparent hepatic lymphoma were studied by means of CEUS prior to B-mode imaging.Results: Using B-mode imaging, lesions were hypoechoic in n = 37 (97.4 %) cases, while a focal lymphoma lesion was echo-rich in 1 case (2.6 %). For comparison, with CEUS, a hyperenhanced signal during the arterial phasewas observed in n = 9 (23.7 %), an isoenhanced signal in n = 17 (44.7 %) and a hypoenhanced signal in n = 12 (31.6 %) cases. During the portal phase n = 2 (5.3 %) lesions were isoenhanced and n = 36 (94.7 %) were hypoenhanced followed by a hypoenhancement in n = 38 (100 %) cases in the late phase.Conclusion: Lymphomas of the liver can cause different contrast accumulation in the arterial phase of CEUS. Furthermore, a clear differentiation from other malignant liver lesions such as metastases is crucial as different contrast accumulation in the arterial phase of CEUS is observed. In the late phase, hepatic lymphomas lead to a hypoenhancement in CEUS, also known as a " wash-out" phenomenon. In conclusion, CEUS is helpful to differentiate hepatic lesions by means of evaluating the malignancy or benignancy. In this regard, the application of CEUS can help to find the right diagnosis. A final discrimination between malignant liver lesions, such as liver lymphomas, metastasis or HCC, remains impossible.

e14047 Background: According to the German S3 guidelines (Schmiegel et al., 2008), groups (gr) for suggested tx intensity are defined as based on an outcome-oriented algorithm (Schmoll & Sargent, Lancet 2007): Gr 1: pts with resectable liver mets (CLM), Gr 2: pts with CLM, potentially resectable after conversion tx, Gr 3a/b: pts with incurable disease, with disease related symptoms or at risk for rapid deterioration (3a) or without latter conditions (3b), gr 4: elderly or frail patients. In gr 2 and 3a, intense tx regimes (IT), by triple chemo or with targeted agents (TA), are recommended, whereas in 3b and 4, sequential tx starting with single agent or doublet tx are regarded as an option. Methods: A representative sample of 82 sites was selected with regard to the distribution of treated prevalence in institutions. Pts. characteristics as well as treating physicians suggestion for group distribution (according to guidelines), and tx characteristics were evaluated. Results: Data include 636 pts with first-line tx (Q4 '09): Distribution per gr is: 26% gr 1 (immediate surgery); in pts with upfront systemic tx: 16% gr 2, 12% gr 3a, 20% gr 3b, and 26% gr 4. Pts. in gr 2 were significantly (all <0.05) younger, had better performance status (PS), lack of comorbidity, had tx decision in non-university institutions and kras testing, but no more TA or IT. By contrast to the intention, IT and TA were given without statist. diff. in all gr., with the highest number (69% and 64%) in symptomatic pts (gr 3a). In a multivariate cluster analysis, 3 clusters overall including 89% of pts were determined (all p<0,05). In the only cluster with significantly higher use of TA, pts were younger (<70 y.), in better PS (≥80% KI), and asymptomatic (independent whether from tumor or lack of comorbidity). Conclusions: In clinical practice, the use of the complex, outcome-orientated determination system is not generally accepted. The decision making on tx intensity is rather based on pts characteristics and institutional factors. This underlines the need for development of further models.

To the Editor: Primary sclerosing cholangitis (PSC), pericholangitis, gallstones, and chronic hepatitis are common hepatobiliary disorders noted in association with inflammatory bowel disease (IBD). Echo-rich periportal cuffing (ErPC) constitutes a rare ultrasonographic phenomenon characterized by periportal encasement of the liver, also referred to as ‘‘fixed star heaven phenomenon’’ due to its distinctive appearance resembling ‘‘stars’’ and ‘‘stripes.’’ Cases of ErPC have been described in a variety of conditions such as hepatitis, IBD, and liver transplants. Previously, we evaluated 10,500 ultrasound examinations for periportal cuffing and assessed the associated clinical diagnoses. Strikingly, ErPC occurred most frequently in patients with Crohn’s disease (CD) and ulcerative colitis (UC). Surprisingly, the etiopathogenesis of ErPC is entirely unknown in IBD and the sonographic phenomenon has not been analyzed by other imaging modalities before. A current hypothesis is that ErPC occurs due to the relative increase in echo reflectors caused by lymphatic fluid obstructing the periportal areolar tissue, as observed in liver transplants or severe hepatitis; however, ErPC may also be the result of extraintestinal liver inflammation in IBD resulting in periportal zones of increased echogenicity. Figure 1 displays the typical sonographic appearance of ErPC in IBD. Here we systematically analyzed for the first time 4 patients with IBD (2 CD, 2 UC, 2 male, 2 female; mean age: 41 years) and ErPC by magnetic resonance imaging (MRI) / magnetic resonance cholangiopancreatography (MRCP), contrast-enhanced ultrasonography (CEUS), and serological tests in order to shed light on this rare sonographic phenomenon. Initially, ErPC was discovered by routine abdominal ultrasonography in our IBD outpatient clinic. In all patients, liver functions tests showed normal results and hepatitis A, B, and C, autoimmune hepatitis, and primary biliary cirrhosis (PBC) were ruled out. At the time of abdominal imaging ErPC was not associated with acute flares of intestinal inflammation as evidenced by low and medium Crohn’s Disease Activity Index (CDAI) scores (mean: 140). Following sonographic detection of ErPC, patients were evaluated by MRI/ MRCP. For PSC, typical morphological findings on MRCP include multiple segmental luminal irregularities, with strictures alternating with dilatations (‘‘beading’’) and peripheral bile duct attenuations (‘‘pruning’’). In contrast, low signal intensity periportal lesions (‘‘periportal halo sign’’) on T2weighted MRI/MRCP are caused by periportal edema or periportal lymph fluid accumulation and have been recently reported in patients with PBC and other hepatobiliary conditions. Interestingly, MRI/MRCP findings of all 4 patients with confirmed ErPC on ultrasonography showed no pathological features of the intrahepatic and extrahepatic biliary tree, thus ruling out active PSC as well as periportal fluid accumulation. CEUS with microbubble contrast medium (Sonovue, Bracco, Milan, Italy) showed an unspecific hypoechoic contrast enhancement in both the arterial (5–30 seconds) and the parenchymal phase (3–5 minutes), further supporting the absence of periportal fluid collection. Strikingly, perinuclear antineutrophil cytoplasmatic antibodies (p-ANCA) but not cytoplasmic ANCA (c-ANCA) were markedly elevated in all 4 patients (titers ranging from 1:40–1:600), suggesting a possible role of ErPC in the development of autoimmune/immune-mediated inflammatory liver disorders. Intriguingly, sonographic follow-up examinations in our 4 patients revealed that ErPC completely disappeared after a few weeks only to reappear after several weeks. This ‘‘on-and-off’’ nature of ErPC, positive p-ANCA titers, and the fact that periportal edema and lymph fluid obstruction could be excluded by MRI/ MRCP and CEUS prompted us to hypothesize that ErPC results from aberrant trafficking of mucosal lymphocytes to the portal tract of the liver via the enterohepatic circulation. Although there is still a paucity of experimental data, the role of such an enterohepatic lymphocyte pathway is hotly debated in the pathogenesis of extraintestinal complications in IBD. For PSC, which is associated with IBD in up to 85%, the hypothesis has been formulated that the destruction of bile ducts is mediated by long-lived memory T cells originally activated in the gut and recruited to the liver due to inflammation-induced expression of chemokines and adhesion molecules. The first evidence for such a paradigm is provided by recent data showing that the gut-homing mucosal addressin cellular adhesion molecule-1 (MAdCAM-1) and CCL25 are detected in liver endothelium of PSC, whereas under normal circumstances expression of these molecules is restricted to the gut. Furthermore, several mouse models of IBD such as the SAMP-1/ Yit mouse and the IL-2Ra (CD25)-deficient mouse have been recently shown to develop not only colitis but also biliary inflammation closely resembling histological features of primary biliary cirrhosis. To conclude, ErPC is a rare sonographic phenomenon that is frequently associated with IBD. Here we systematically analyzed for the first time 4 patients with ErPC and IBD CopyrightVC 2009 Crohn’s & Colitis Foundation of America, Inc. DOI 10.1002/ibd.21165 Published online 21 December 2009 inWiley InterScience (www.interscience.wiley.com).

PURPOSE:B-mode ultrasound (US) of hepatic candidiasis (HC) shows an uncharacteristic pattern. The aim of this study is to display the pattern of HC by performing contrast-enhanced ultrasound (CEUS).PATIENTS AND METHODS:Between May 2006 and June 2008 HC was diagnosed in 12 patients (4 female, 8 male) by clinical and sonographic findings. The underlying diseases were acute leukemia (n = 10), aplastic anemia (n = 1), and testicular cancer (n = 1) in either the state of complete remission (n = 10) or relapse (n = 2). Due to neutropenic fever after chemotherapy all of the patients had received antifungal therapy. When HC was diagnosed all patients were afebrile and in a recovered hematological constitution. Additional diagnostic procedures were histological examination (n = 5), computed tomography (n = 8) and sonographic follow-up examinations (n = 12). All patients were examined with B-mode US and CEUS.RESULTS:In B-mode US the lesions were hypoechoic (n = 12), multiple (n = 10) and > 1 cm (n = 8) as well as > 2 cm (n = 4) in diameter. During CEUS no enhancement of contrast media in the centre of the lesions was seen in all cases during both phases. Additionally, in the arterial phase, the lesions showed no rim enhancement (n = 3) (type I), an isoechoic rim enhancement (n = 5) (type II), or a hyperechoic rim enhancement (n = 4) (type III). During sonographic follow-up a complete regression of the lesions (n = 9) or a stable disease (n = 2) was seen. One patient died due to a relapse.CONCLUSION:The CEUS pattern of HC is variable but characteristic. Therefore, CEUS should be performed in all patients with suspected HC.

Purpose: To characterize the pattern of contrast-enhanced ultrasonography (CEUS) in splenic metastases compared to standard B-mode ultrasonography.Materials and Methods: Between January 2004 and March 2009, about 50,000 abdominal ultrasound examinations were performed, and n = 279 (< 0.6%) of focal splenic lesions were detected of which n = 32 (11.5%) were highly suggestive for splenic metastases of various solid tumors. The number of lesions, size, echogenicity, rim appearance, presence of halo sign and necrosis were recorded via B-mode sonography. Contrast enhancement was determined in the arterial phase (5 - 30 sec) and parenchymal phase (3 - 5 min). B-mode sonography and CEUS were compared in terms of the visibility of splenic metastases. All data was evaluated retrospectively.Results: On B-mode sonography lesions were solitary n = 18 (56%), multiple n = 14 (44%), < 2cm n = 11 (34%), <= 2 cm n = 21 (66%), hypoechoic n = 14 (44%), isoechoic n = 12 (38%) and hyperechoic n = 6 (19%), with regular rim appearance n = 27 (84%), and with irregular rim appearance n = 5 (16%). During the arterial phase CEUS lesions were hypoechoic n = 21 (66%), isoechoic n = 2 (6%), hyperechoic n = 1 (3%) and complex n = 8 (25%). During the parenchymal phase lesions were hypoechoic n = 24 (75%) and complex n = 8 (25%). CEUS provided improved visualization of splenic metastases in n = 12 (38%) cases.Conclusion: CEUS of splenic metastases is characterized by reduced contrast enhancement in both the arterial and the parenchymal phase in most cases. Moreover, CEUS improved the visualization of splenic metastases in about 40% of cases in comparison to standard B-mode sonography.

The term myeloproliferative disease (MPD) includes various chronic hematologic disorders, for example, chronic myeloid leukemia, essential thrombocytosis, polycythemia vera and osteomyelofibrosis (Burkhardt R et al. J Clin Pathol 1986; 39: 237 – 252). MPD involves splenomegaly, especially in the accelerated phase of disease, and often results in splenic infarction, which appears in ultrasound as hypoechoic lesions (Görg C et al. Radiology 1990; 174: 803). In contrast, hyperechoic/isoechoic splenic lesions are rare among patients with MPD, and the cause of these lesions is mostly unknown due to the lack of histological confirmation (Görg C et al. Ann Hematol 2004; 83: 14 – 17).

PURPOSETo present our experience with contrast-enhanced ultrasound (CEUS) in patients with epiploic appendagitis (EA).PATIENTS AND METHODSFrom May 2005 to December 2007, 15 patients with the clinical and B-mode sonographic diagnosis of EA (13 men and 2 women, aged 11 - 78 years) were included in the study. All patients were examined by CEUS. The extent of contrast enhancement of the fatty tissue masses was measured using the normal surrounding fat tissue enhancement as an in vivo reference (no, hyperechoic, mixed enhancement). B-mode sonographic follow-up examinations were performed in all cases. As additional diagnostic procedures, computed tomography (n = 8), colonoscopy (n = 5), and surgery (n = 1) were used.RESULTSWith CEUS all 15 masses showed a central area of no enhancement. Masses with a central unenhanced area and with broad perilesional enhancement (> 1 mm) were classified as mixed enhancement (n = 11). In the 4 cases classified as no enhancement the central unenhanced area was demarcated by only a marginal hyperechoic rim (< or = 1 mm).CONCLUSIONEA is diagnosed by clinical, laboratory and B-mode sonographic patterns. EA shows a fairly characteristic CEUS feature. CEUS may therefore be helpful to confirm the diagnosis of EA in equivocal cases.

PURPOSE:Transcutaneous ultrasound is not a common imaging procedure in patients with fever. The aim of this study is to demonstrate the diagnostic value of a complete standardized ultrasound examination of patients with fever.MATERIALS AND METHODS:From March 2003 to October 2003, we examined 200 patients with fever using ultrasound. We performed a standardized ultrasound examination including the collar, thoracal, cardial, abdominal regions, and small parts/soft tissue regions depending on clinical symptoms. We retrospective analyzed the patient history regarding fever (origin known vs. unknown) and the diagnostic value of ultrasound (no ultrasound diagnosis vs. ultrasound diagnosis).RESULTS:At the time of inclusion in the study, the origin of fever was known in 124 of 200 patients (62 %) and unknown in 76 of 200 patients (38 %). Ultrasound did not result in a diagnosis in 86 of 200 patients (43 %). A pathological finding was detected in 114 of 200 cases (57 %) as the origin of the fever. New causes for fever were found in 24 of 200 patients (12 %) by means of ultrasound. The most common diagnoses (67 %) in this subgroup were abscesses and splenic infarcts.CONCLUSION:In the clinical course of patients with fever, ultrasound is a diagnostic tool for the documentation and exclusion of medical findings. With this study we were able to show that ultrasound results in the correct diagnosis in one third of patients with fever of an unknown origin and may provide important additional information in patients with fever.

Aim: To describe B-mode sonographic patterns of splenic metastases and to evaluate clinical data regarding tumour staging, kind of tumour and survival of patients with splenic metastases.Methods: From 1988 till October 2002, about 168000 abdominal examinations were performed in an internal ultrasound laboratory. During this time, n = 59 patients with splenic metastases were detected who qualified for the retrospective study design. The following data were evaluated: echomorphology of splenic metastases, tumour staging, kind of underlying tumour, and survival rates of patients with splenic inetastases.Results: The median age of patients was 61.8 years (SD +/- 10.9). Lesions were hypoechoic n = 19 (32%), isoechoic n = 15 (25.5%), hyperechoic n = 10 (17%) und complex n = 15 (25.5%). A hypoechoic rim was found in n = 18 patients (31%). An additional spread into other organs was seen in 56 cases (95%). Underlying cancers were carcinoma of unknown primary tumours (CUP) n = 12 (20.3%), lung cancer n = 11 (18.6%), ovarian cancer n = 7 (11.9%), colorectal cancer n = 6 (10.2%), breast cancer n = 6 (10.2%), malignant melanoma n = 5 (8.4%), and others n = 12 (20.3%). The median survival time for all patients was 8.7 months. The worst prognosis within the subgroup analysis was found for patients with CUP-syndrome who had a median survival time of 2.7 months.Conclusion: The sonographic pattern of splenic metastases is variable. Metastases to the spleen indicate a terminal stage cancer disease and is associated with an extremely short survival time. 20% of underlying cancers were CUP-syndromes with the worst prognosis of all subgroups.

Purpose: To determine the prevalence of echo-rich and echo-poor periportal Cuffing in patients from a German tertiary referral hospital and correlate uitrasonographic findings with clinical data.Materials and Methods: From April 2002 till April 2008 about 10500 abdominal examinations were performed by a single physician in our interdisciplinary ultrasound unit. During this time, n = 100 patients (62 male/38 female) with periportal cuffing of the liver were detected qualifying for the retrospective study design. Echomorphology of periportal cuffing was evaluated and clinical diagnoses of the underlying diseases were clustered in four main groups: Liver diseases, haematological diseases, bowel diseases and others. Furthermore, liver function tests and body mass index were determined.Results: The mean age of the patients was 57.06 years (SD +/- 19.47). Mean body-mass-index was 24.76kg/m(2) (SD +/- 4.28). Periportal cuffing was echo-poor in n=9 (9%) and echo-rich in n=91 (91%). Echo-poor periportal cuffing was significantly more often associated with malignant diseases as compared to echo-rich periportal Cuffing (78 vs. 36%) (p < 0.025). Liver diseases (n=33) were malign n=10 (10%), autoimmune n=8 (8%), infectious n=8 (8%) and cholestatic n=7 (7%). Bowel diseases (n = 34) originated from the upper gastrointestinal tract n = 7 (7%), lower gastrointestinal tract n = 21 (21%) and the pancreas n = 6 (6%). Haematological disorders (n = 15, 15 %) were chronic myeloproliferative n=2 (2%), lymphoma n=8(8%),leukemia n = 4(4%)and miscelaneous n = 1 (1 %). Other diseases accounted for 18 (18%) of cases. Aspartat-aminotrasferase (AST) and alanin-aminotransferase (ALT) were elevated in 39 patients (40%) and 34 patients (35%), respectively. Total bilirubin was elevated in 35 patients (36%). Alkaline phosphatase (AP) was detected above normal range in 49 patients (50%) whereas g-glutamyl-transferase was elevated in 58 patients (59%).Conclusion: Periportal cuffing of the liver is an extremely rare ultrasonographic phenomenon with a prevalence of similar to 0.95% in our unit. Echo-rich periportal cuffing occurs more frequently than echo-poor periportal cuffing. The majority of echo-poor periportal cuffing is associated with malignant disorders, in particular haematological diseases, whereas echo-rich periportal cuffing is most frequently seen in inflammatory bowel disease patients.

Purpose: Examination of the prognostic importance of sonographically diagnosed pleural defects in patients with deep vein thrombosis (DVT) who are clinically asymptomatic for lung emboli (LE).Material and method: n = 124 patients with a sonographically diagnosed DVT and without clinical symptoms for an LE were accepted for this retrospective study. The thorax was subsequently sonographically examined in all patients. The patients were split into two groups (group 1: with pleural defects; group 2: without pleural defects). These groups were observed for an average of 36.6 months. The endpoints death and recurrence of pulmonary embolism or thrombosis were documented. The survival time was calculated using the Kaplan-Meier analysis.Results: Of the 124 patients, n = 50 (40.3 %) had pleural defects (group I) and n = 74 (59.7 %) had no pleural defects (group 2) on thoracic sonography. During the time of observation, n=9 patients experienced a recurrent event of thrombosis or pulmonary embolism. In total, n = 39 (31.5 %) patients died (group 1: n = 16, group 2: n = 23 patients). The one-year mortality rate for patients with pleural defects was 24% in group 1 and 22 % in group 2. The differences in the survival curves were not statistically significant (p = 0,7581).Conclusion: The sonographic diagnosis of pleural defects that are indicative for small embolism for patients with diagnosed deep vein thrombosis (DVT) and without clinical symptoms for an LE has no prognostic significance with respect to death or recurrent pulmonary embolism or thrombosis. Routine thorax sonography for such patients does not seem to be indicated.