Deep Vein Imaging

Question 1

Trifurcation in the calf

Answer 1

Anterior tibial
Posterior tibial
Peroneal

Question 2

Where do thrombus’ occur more often in the calf

Answer 2

Peroneal and posterior tibial veins (versus anterior tibial)

Question 3

Whats more lateral posterior tibial or peroneal

Answer 3

Posterior tibial (will be more anterior on US)

Question 4

Main drainage conduit for the blood flow from the calf

Answer 4

Popiteal vein

Question 5

Popliteal vein normal variant (25%)

Answer 5

Duplicated

Because of high juncture of posterior tibial and peroneal trunks

Question 6

Most DVT extending into popliteal vein originate in the

Answer 6

Soleal sinus vein

Question 7

The soleal sinus vein dumps into (2) whereas the gastroc dumps into (1)

Answer 7

Posterior tibials or peroneals

Popliteal

Question 8

What is the most superior branch of the trifurcation

Answer 8

Anterior tibial trunk

Question 9

Order of branching from popliteal superior to inferior

Answer 9

Pop V - anterior tibial trunk (most superior) - tibioperoneal trunk - common tibial trunk & common peroneal trunk - paired tibial & paired peroneal

Question 10

T/F the anterior tibials are not easy to see on US

Answer 10

True

Question 11

Why do the ______ almost never develop DVT. When are these usually imaged

Answer 11

Anteriot tibials do not communicate with soleal sinus. Injury to lateral calf

Question 12

Paired veins near the tibia

Answer 12

Posterior tibial veins

Question 13

Paired veins near the fibula

Do these appear larger or smaller

Answer 13

Peroneal veins, larger than posterior tibials

Question 14

What passes through MM and achielles tendon

Answer 14

Posterior tibial veins

Question 15

What location poses a higher risk of embolizaiton

Answer 15

Thrombosis above the trifurcation

Question 16

T/F most calf veins resolve spontaneously

Answer 16

True

Question 17

T/F d-Dimer is not reliable for calf DVT. What is the sensitivity?

Answer 17

True

65%

Question 18

You can rule out a pulmonary embolism if what two veins are patent

Answer 18

Popliteal vein

Femoral vein

Question 19

How sensitive is doppler to diagnosing calf DVT

Answer 19

70%

Question 20

T/F gastrocs pose a lesser risk of embolisaiton

Answer 20

True

Question 21

Calf vein imaging limitations (3)

Answer 21

Obese
Severe edema
Acoustic windows

Question 22

D/D (3)

Answer 22

Bakers cyst
Superficial venous thrombosis of varices
Calf muscle tears

Question 23

What is a common variant of deep calf veins

Answer 23

Single deep calf vein instead of a pair (usually larger than if paired)

Question 24

The popliteal vein often gets confused with the ___ vein

Answer 24

Gastrocnemius vein

Question 25

What do you do if it’s difficult to locate both trunks when scanning

Answer 25

Follow the posterior tibials (medial aspect) first then go bacm to the trunk and follow the peroneals

OR

Question 26

_____ is necessary to fill the lumen with colour due to lack of spontaneity in the calf

Answer 26

Augmentation