Acute Venous Pathology

Question 1

What is the learning outcome of the pathophysiology of acute venous disease?

Answer 1

Differentiate the pathophysiology of acute and chronic venous disease.

Question 2

What are the objectives of studying acute venous disease?

Answer 2

1. Describe the evolution of thrombus formation and propagation.
2. Name the signs, symptoms and risk factors of acute deep venous thrombosis (DVT) and chronic venous insufficiency (CVI).
3. Discuss the factors that lead to chronic venous insufficiency.
4. Explain other pathologies that demonstrate symptoms of venous disease.
5. Describe treatments for acute and chronic venous disease.
6. List other medical tests that aid in diagnosis of venous disease.

Question 3

What is the most common test for ruling out a DVT?

Answer 3

Ultrasound of the lower extremity.

Question 4

What are the complications of untreated DVT? 2

Answer 4

1. Pulmonary embolus (PE)
2. Chronic venous insufficiency (CVI).

Question 5

What are the components of Virchow’s Triad?

Answer 5

1. Stasis
2. Intimal injury
3. Hypercoagulability

Question 6

What factors contribute to venous stasis? 6

Answer 6

1. Immobility due to illness, injury or surgery
2. Congestive heart failure
3. Chronic obstructive pulmonary disease (COPD)
4. Obesity
5. Pregnancy
6. Previous DVT

Question 7

What is hypercoagulability?

Answer 7

A state where blood is more likely to clot, influenced by conditions like cancer, pregnancy, and certain genetic factors.

Question 8

What is the Well’s Score used for?

Answer 8

To assess the likelihood of DVT based on clinical history and signs.

Question 9

What does a D-dimer assay indicate?

Answer 9

It detects the formation of acute thrombus and indicates the probability of a DVT.

Question 10

Where does thrombus formation typically start in the lower extremity?

Answer 10

In the soleal sinus, calf veins, or at the valve cusps.

Question 11

What is the appearance of an acute thrombus on ultrasound?

Answer 11

It appears as dilation of the vein with lack of compressibility, and can be anechoic or hypoechoic to surrounding tissue.

Question 12

What is the difference between complete and partial thrombus?

Answer 12

Complete thrombus occludes the vein, while partial thrombus allows some blood to flow within the lumen.

Question 13

What is May-Thurner Syndrome? Which demographic is more affected?

Answer 13

1. Compression of the left common iliac vein between the right common iliac artery and spine
2. More prevalent in females.

Question 14

What is Paget-Schroetter Syndrome? What is often due to?

Answer 14

1. The most common form of axillo-subclavian thrombosis in ambulatory, healthy people
2. Often due to anatomical variations.

Question 15

What is Phlegmasia Cerulea Dolens?

Answer 15

A condition where collateral veins become thrombosed, leading to massive obstruction of venous outflow and potential gangrene.

Question 16

What are the categories of medical treatment for acute venous disease? 2

Answer 16

1. Anticoagulation therapy
2. Thrombolytic agents

Question 17

What is the purpose of a caval filter?

Answer 17

To prevent thrombus from the lower limbs from propagating to the lungs, causing a pulmonary embolism.

Question 18

What is superficial thrombophlebitis?

Answer 18

Acute thrombus in the superficial veins, diagnosed clinically as a ‘hard cord’ under the skin.

Question 19

What is a thrombus?

Answer 19

A thrombus is a blood clot that can occur in the superficial veins of the extremities.

Question 20

How is thrombus formation diagnosed clinically?

Answer 20

It is usually diagnosed clinically as a ‘hard cord’ palpated under the skin.

Question 21

What imaging technique is used to delineate the extent of a thrombus?

Answer 21

Ultrasound is used to delineate the extent of the thrombus, particularly at major confluences into the deep system.

Question 22

What is the clinical significance of superficial thrombus? 2

Answer 22

1. Superficial thrombus has varied clinical significance
2. Some treat it as a DVT while others prescribe a warm compress and anti-inflammatories.

Question 23

What percentage of superficial thrombosis has a concurrent DVT or PE?

Answer 23

Approximately 25% of superficial thrombosis has a concurrent DVT or PE.

Question 24

When is anticoagulation therapy indicated for a thrombus?

Answer 24

Anticoagulation therapy is indicated if the thrombus is 5 cm or more in length or is within 3 cm of the SFJ.

Question 25

What is a Venogram?

Answer 25

A Venogram is an X-ray exam where contrast is injected into the small veins of the foot to demonstrate the venous system of the leg.

Question 26

What does a complete thrombus appear as on a Venogram?

Answer 26

A complete thrombus is seen as a lack of filling of the contrast within the vein at its expected location.

Question 27

What is the Gold Standard for diagnosing venous thromboembolic disease?

Answer 27

The Venogram is considered the Gold Standard, meaning the accuracy of other studies is compared to it.

Question 28

What is a Pulmonary Angiogram or CTPA used for?

Answer 28

It is the standard test to rule out pulmonary embolism (PE).

Question 29

What does a VQ Scan involve?

Answer 29

A VQ Scan involves inhaling a radioactive gas and injecting a radiopharmaceutical to detect the presence of a PE.

Question 30

What is Isotope Venography?

Answer 30

Isotope Venography is a Nuclear medicine study that uses a radiopharmaceutical injected into the blood to tag a thrombus.

Question 31

What is a Baker’s Cyst?

Answer 31

A Baker’s Cyst is a dilation of the bursa that communicates with the knee joint, usually found medial to the knee joint.

Question 32

How do hematomas appear on ultrasound?

Answer 32

Hematomas appear as a hypoechoic mass with ill-defined borders, contained within muscles or tissues.

Question 33

What is edema?

Answer 33

Edema is the result of fluid overload seen in the interstitial tissues.

Question 34

What are common causes of edema? 4

Answer 34

Common causes include:
1. Heart failure
2. Fluid overload
3. DVT
4. Venous obstruction.

Question 35

What is the difference between an abscess and cellulitis? 2

Answer 35

1. An abscess is an enclosed collection of pus
2. While cellulitis is a diffuse collection of fluid within the subcutaneous tissue.

Question 36

What can enlarged lymph nodes be mistaken for and what can it cause?

Answer 36

Enlarged lymph nodes can be mistaken for thrombosed vein and cause limb swelling or compression of the veins.

Question 37

What should be considered when a patient presents with a lump behind the knee?

Answer 37

A popliteal aneurysm should be considered when a patient presents with a lump or pain behind the knee.