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Vascular > Chapter 18: Duplex Ultrasound Imaging of the Upper Extremity Venous System > Flashcards

Chapter 18: Duplex Ultrasound Imaging of the Upper Extremity Venous System Flashcards

1
Q

newly formed clotted blood within a vein, generally less than 14 days old

A

acute thrombus

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2
Q

residual material present within a vein for a period of several weeks or months; also called chronic change, scarring

A

chronic post-thrombotic changes

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3
Q

a vein that is the companion vessel to an artery and travels deep to the muscular fascia and lies within the deep muscular compartments of the arm

A

deep vein

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4
Q

a vein that is superficial to the muscular fascia and the muscular compartments of the arm; travels within superficial fascia compartments; has no corresponding companion artery

A

superficial vein

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5
Q

an inward projection of the intimal layer of a vein wall producing two semilunar leaflets, which prevent the retrograde movement of blood flow

A

valve

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6
Q

thrombus appears poorly attached to the wall

A

acute thrombus

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7
Q

vein appears spongy/deformable with transducer pressure

A

acute thrombus

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8
Q

thrombus has a smooth border

A

acute thrombus

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9
Q

material in veins may appear as strands or bands

A

chronic post-thrombotic changes

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10
Q

veins may appear contracted

A

chronic post-thrombotic changes

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11
Q

material in veins may have an irregular border

A

chronic-post thrombotic changes

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12
Q

thrombus is rigid, nondeformable and firmly attached

A

chronic post-thrombotic changes

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13
Q

veins will partially compress but not able to completely coapt walls

A

partial nonocclusive thrombus

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14
Q

will augment with distal compression

A

partial nonocclusive thrombus

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15
Q

little to no change in flow pattern with Valsalva

A

partial nonocclusive thrombus

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16
Q

echogenic material around brightly echogenic, straight, parallel lines

A

venous catheter-associated thrombus

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17
Q

Virchow Triad

A

venous stasis
hypercoaguability
vessel wall injury

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18
Q

patients who present with upper extremity venous thrombosis without a history of venous puncture or cannulation

A

primary venous thrombosis

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19
Q

result of compression of subclavian vein at thoracic inlet around area of first rib

A

primary venous thrombosis

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20
Q

through to be result of years of repetitive trauma and intermittent compression of subclavian vein

A

primary venous thrombosis

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21
Q

Primary venous thrombosis is also called ______ or _____.

A

effort thrombosis
Paget-Schroetter syndome

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22
Q

Most common in young, athletic muscular males

A

primary venous thrombosis

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23
Q

most common venous thrombosis

A

secondary venous thrombosis

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24
Q

originates from use of central venous catheters or patient malignancy

A

secondary venous thrombosis

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25
Q

symptoms of venous thrombosis

A

unilateral arm or hand swelling
superficial palpable cord
erythema
pain
tenderness

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26
Q

symptoms of superior vena cava thrombosis

A

facial swelling
dilated chest wall collaterals
indwelling catheters
history or venous catheters

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27
Q

symptoms of pulmonary embolism

A

chest pain
tachypnea
tachycardia

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28
Q

While performing transducer compressions, the sonographer should compress every ____ cm

A

2-3

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29
Q

usually terminates into subclavian vein

A

external jugular vein

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30
Q

come together behind sternum to form superior vena cava

A

brachiocephalic vein

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31
Q

confluence of subclavian veins and internal jugular veins

A

origin of brachiocephalic veins

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32
Q

What two veins cannot be compressed in the upper extremity?

A

brachiocephalic
subclavian

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33
Q

Where does the cephalic vein terminate into?>

A

subclavian vein

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34
Q

Beyond the terminus of cephalic vein, the subclavian vein becomes the ______

A

axillary vein

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35
Q

travels superficially near skin line across shoulder and along arm at anterior-lateral border of biceps muscle

A

cephalic vein

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36
Q

superficial vein that connects cephalic and basilic veins

A

median cubital vein

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37
Q

terminates at junction of cephalic and subclavian veins

A

axillary vein

38
Q

The axillary vein becomes the ____ vein

A

brachial

39
Q

formed by junction of two radial and two ulnar veins at level of antecubital fossa

A

brachial vein

40
Q

course along volar aspect of forearm

A

radial veins

41
Q

course along volar aspect of ulnar side of forearm

A

ulnar veins

42
Q

located at level where basilic vein terminates with axillary vein

A

basilic vein

43
Q

communicates with cephalic vein via medial cubital vein

A

basilic vein

44
Q

thin linear strands or strings of material located within venous lumen

A

synechaie

45
Q

Normal spectral Doppler shows ___ phasicity with respiration

A

normal

46
Q

Complete thrombus spectral Doppler

A

none

47
Q

Partial thrombus spectral Doppler

A

continuous flow

48
Q

pulsatile flow that displays elevated velocities throughout cardiac cycle

A

upper extremity hemodialysis fistula or graft

49
Q

will appear in lumen of vein as bright, straight, parallel echoes

A

venous catheter

50
Q

What is the most common reason that secondary venous thrombosis in the upper extremities has become more common?

A

increased injury to vein walls

51
Q

Unlike the lower extremities, what do the upper extremities NOT have that may allow spontaneous thrombus formation?

A

soleal sinuses

52
Q

What is primary venous thrombosis due to compression of the subclavian vein at the thoracic inlet termed?

A

Paget-Schroetter syndrome

53
Q

A patient presents to the vascular lab for upper extremity venous evaluation with face swelling and prominent veins on the chest and neck. What do these findings suggest?

A

superior vena cava thrombosis

54
Q

Transducer compressions are limited over several veins in the upper extremity because of limited access from bony structures. What are the most common veins that are NOT able to be compressed?

A

brachiocephalic and subclavian veins

55
Q

What is the most appropriate transducer for mapping of the upper extremity superficial venous system?

A

10-18 MHz straight linear array

56
Q

Why are the subclavian and jugular veins assessed with the patient lying flat?

A

to reduce hydrostatic pressure

57
Q

How does the external jugular vein lie in relation to the internal jugular vein?

A

posterior

58
Q

At the confluence with which vein does the brachial vein become the axillary vein?

A

basilic vein

59
Q

During an upper extremity venous examination, the technologist has made the patient take in a quick, deep breath through pursed lips while viewing the subclavian vein. What is the purpose of this action?

A

collapse/coapt the subclavian vein

60
Q

In the upper extremity, in general, which venous system is larger?
a. deep systep
b. superficial system
c. deep and superficial are of equal size
d. perforating system

A

b

61
Q

During an upper extremity venous duplex examination, the technologist notes significant pulsatility in the spectral Doppler waveform from the internal jugular vein. What does this finding suggest?

A

normal finding for the IJV

62
Q

Which vessel may NOT be routinely evaluated in a UE venous duplex examination but is often added in the event of significant thrombosis?

A

external jugular vein

63
Q

Because of the location of the brachiocephalic veins, documentation of patency of these vessels is usually performed with which of the following?
a. grayscale image with additional color flow spectral Doppler images
b. grayscale imaging alone
c. grayscale image with and without transducer compression
d. color-flow imaging alone

A

a

64
Q

Which vessel connects the basilic and cephalic veins?

A

medial cubital vein

65
Q

Which forearm vessels are NOT routinely evaluated during upper extremity venous duplex testing?
a. basilic and cephalic veins
b. basilic and ulnar veins
c. cephalic and radial veins
d. radial and ulnar veins

A

d

66
Q

A 34 year old female presents to the vascular lab with a 1 day history of arm swelling and redness. The patient has recently had a PICC line inserted. During the duplex evaluation, the axillary and subclavian veins are incompressible and are dilated with spongy-appearing, hypoechoic echoes noted within their lumens. What do these findings suggest?

A

acture venous thrombosis

67
Q

A 78 year old male presents to the vascular lab with right arm swelling for the past several days. The patient notes that he is currently being treated for cancer. During the upper extremity duplex examination, decreased pulsatility is noted in the right internal jugular and subclavian ceins as well as Rouleaux (slow) flow formation. What do these findings suggest?

A

a more proximal obstruction, likely in the brachiocephalic vein or superior vena cava

68
Q

During an upper extremity venous duplex evaluation, color flow is noted filling the axillary vein. However, in a transverse view, the axillary vein is noted to be only partially compressible. Which of the following could explain these findings?
a. color priority set too low and color gain too high
b. color scale too high and color gain too low
c. color priority and scale too high
d. color packet size and gain too low

A

a

69
Q

A 22 year old male patient presents to the vascular lab with a 3 day history of left arm swelling with no apparent injury or risk factors. upon further questioning, the patient does state that he has recently begun weight training. What does the vascular technologist suspect in this patient?

A

effort thrombosis

70
Q

The ____ veins of the arm are more affected by venous thrombosis than in the legs.

A

superficial

71
Q

Signs and symptoms of upper extremity venous thrombosis are ____ to symptoms in the lower extremity.

A

similiar

72
Q

Thrombosis in the upper extremity veins is now most commonly caused by more frequent introduction of ____ and ____ into arm veins

A

catheters
needles

73
Q

Common veins to use for catheter placement and, therefore, for venous thrombosis are the _____ vein and the ____ vein.

A

subclavian
internal jugular

74
Q

Veins that are typically used for the insertion of a PICC line are the _____ veins or the ____ veins.

A

basilic
cephalic

75
Q

Individuals who present with upper extremity thrombosis secondary to compression of the subclavian vein at the thoracic inlet have what is termed _____ thrombosis or _____ syndrome.

A

effort
Paget-Schroetter

76
Q

Superior vena cava syndrome often causes facial _____ and prominent, dilated ____ collateral veins.

A

swelling
chest wall

77
Q

_____ patients may present for upper extremity venous evaluation before catheter placement, venous mapping for bypass, and before placecment of pacemaker wires/

A

Asymptomatic

78
Q

As in the lower extremities, gentle compression with the transducer is applied over upper extremity veins to cause the walls to ____.

A

compress

79
Q

Compression of the _____ and _____ veins is usually not performed because of the position of these vessels in relation to the bony structures of the shoulder.

A

brachiocephalic
subclavian

80
Q

To evaluate the internal jugular, brachiocephalic, subclavian, axillary, and brachial veins, a _____ MHz transducer is typically used; however, it is helpful to use a ____ Mhz transducer when evaluating small forearm veins as well as superficial extremity veins.

A

5-10
10-18

81
Q

When sitting up or lying with the head elevated, hydrostatic pressure causes hte jugular and subclavian veins to _____; therefore, it is preferable to evaluate these vessels witht he patient lying ____.

A

collapse
flat

82
Q

Evaluation of the jugular veins should be included in the upper extremity evaluation because they can be involved in the _____ process or can provide ______ pathways in the presence of upper extremity thrombosis.

A

thrombus
collateral

83
Q

The typical landmark used to identify the internal jugular vein is the ____ artery.

A

carotid

84
Q

Spongy, poorly attached, hypoechoic material visualized within the lumen on a noncompressible, dilated vein is consistent with _____ venous thrombosis.

A

acute

85
Q

Flow reversal in the internal or external jugular veins is often associated with ipsilateral _____ vein thrombus.

A

brachiocephalic

86
Q

The median cubital vein connects the cephalic and basilic veins and is commonly used for _____.

A

venipuncture

87
Q

In veins that are partially thrombosed, the spectral Doppler signal is typically _____ in nature but should display augmentation with distal compression.

A

continuous

88
Q

One method to help determine patency of the central veins is to compare the _____ of the signal from the right or left sides.

A

symmetry

89
Q

Spectral Doppler characteristics of the upper extremity venous system include respiratory ______ and pronounced ______ in the more centrally located vessels.

A

phasicity
pulsatility

90
Q
A

Vascular (33 decks)

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