Duplex Imaging of Upper Extremity Venous System

Question 1

What denotes an acute vs chronic thrombus?

Answer 1

Acute thrombi are usually <14 days old

Question 2

Do superficial or deep veins have an accompanying artery?

Answer 2

Deep veins have an accompanying artery

Question 3

Three major differences between upper and lower extremity veins?

Answer 3

1. Most thrombi in the lower extremity are cause by stasis, which is not true of the upper extremity
2. Superficial veins are affected more in the upper extremity than the lower
3. Veins in lower extremity follow more reliable courses

Question 4

T or F? A thrombus in a superficial vein in the upper extremity is of greater significance than in the lower extremity?

Answer 4

TRUE

Question 5

In what veins are thrombi more aggressively treated?

Answer 5

Subclavian and axillary

Question 6

What is Virchow’s triad in determining pathogenesis of upper extremity thrombosis?

Answer 6

1. Venous stasis
2. Hypercoagulability
3. Damage to venous walls

Question 7

What is the term for a primary UEV thrombosis where patients have no history of venous puncture?

Answer 7

Paget-Schroetter syndrome or effort thrombosis

Question 8

Primary thrombosis occurs due to the repeated compression of what vein?

Answer 8

Subclavian vein as it passes through thoracic inlet

Question 9

In what population is primary UEV most seen? (Paget-Schroetter syndrome)

Answer 9

Young, athletic, muscular males

Question 10

What are the most common reasons for secondary UEV thrombosis?

Answer 10

1. Central venous catheters
2. Malignancy

Question 11

Why is thrombosis in the UEV more common with secondary causes?

Answer 11

More injury to the venous walls due to catheters and needles.

Question 12

What veins are usually used to insert catheters for drug administration and feeding?

Answer 12

IJV and subclavian

Question 13

In what vein are pacemaker wires usually inserted?

Answer 13

Subclavian

Question 14

What does PICC stand for?

Answer 14

peripherally inserted central catheter

Question 15

What symptoms may present with a SVC thrombi?

Answer 15

1. Facial swelling
2. Dilated chest wall with venous collaterals

Question 16

Symptoms in patients with a suspected pulmonary embolism?

Answer 16

1. Tachycardia
2. Chest pain
3. Tachypnea

Question 17

What vein terminates into the subclavian?

Answer 17

Cephalic vein

Question 18

What vein is being assessed using the “sniff test”?

Answer 18

Subclavian

Question 19

What two veins connect with the median antecubital vein?

Answer 19

Cephalic and Basilic

Question 20

What vein should be compressed and documented if there is a suspected superficial thrombophlebitis?

Answer 20

Median cubital vein

Question 21

What vein should be compressed and documented if there is a suspected superficial thrombophlebitis?

Answer 21

Median cubital vein

Question 22

In what vein is a common site for thrombus due to it being common for venipuncture? (site for IV)

Answer 22

Median cubital vein

Question 23

The axillary vein begins at the junction of what veins?

Answer 23

Cephalic and subclavian

Question 24

The brachial veins are formed by the junction of what veins?

Answer 24

Two radial and two ulnar

Question 25

What does the basilic vein terminate into?

Answer 25

Axillary

Question 26

The medial cubital vein connects what two veins?

Answer 26

Cephalic and basilic

Question 27

In what veins should you observe pulsatile flow? (3)

Answer 27

Subclavian
IJV
Brachiocephalic V.

Question 28

When both subclavian veins demonstrate non-pulsatile flow, what should be suspected?

Answer 28

Pathology in SVC

Question 29

SF of a catheter?

Answer 29

Echogenic, straight and parallel echoes

Question 30

In what population is Paget-Schroetter syndrome most commonly seen?

Answer 30

Young, athletic, muscular males

Question 31

What is Paget-Schroetter syndrome also called? (hint: 2 names)

Answer 31

1. Effort thrombosis
2. Thoracic outlet syndrome (TOS)

Question 32

What is the thoracic outlet?

Answer 32

The space between the collarbone and first rib

Question 33

Is primary or secondary UEV thrombosis more common?

Answer 33

Secondary - due to central venous catheters