LE Venous Thrombosis Flashcards
what types of DVT are there and what types of testing are available for diagnosis?
Acute
Chronic
Duplex testing
Doppler testing
what is the difference b/t acute and chronic DVT on US?
acute has a mobile mass chronic usually has thickened walls
characteristics of actue DVT (2D)
thrombus begins in soleal sinuses of valve cusp
more loosely attached, higher risk for embolism, may develop “wormlike” appearance from Rouleaux formation
hypoechoic
dilated vein
Valves thick and not freely moving
what is the best diagnostic finding for acute DVT?
if you find a dvt, what is your next step?
lack of compression.
look at the other leg and the IVC
what does this show?
lack of phasity
what are the doppler characteristics of acute DVT?
if there is calf thrombus, what can you expect w/ compression?
Lack of flow
Flow distal to thrombus will lack phasity
Calf thrombus will decrease augmentation that occurs with calf compression
intra characteristics of acute DVT
Hypoechoic clot, non compressible vein, dilated vein, emboli risk
Wormlike Rouleaux formation – red blood corpuscles pile on each other like a stack of coins.
wha the French term for “roll”
has the appearance of RBC arranged like roll of coins
has sluggish flow on B-mode, heterogenous material moving with respiration and augmentation
Where would obstruction be w/ compressible vessel w/ this formation?
rouleau formation.
with Rouleau formation = proximal obstruction
what happens to the lumen w/ acute DVT?
should you compress after thrombus is found?
it fills. the below lt has some flow around so it is partially obstructed. the rt is completly obstructed
No, just note the location and extent of thrombus from .. to ..
what is lacking if acute DVT is present?
compression and flow
what is this?
may-thurner syndrome
what do you think this is an example of?
Chronic – Doppler
Some flow with color and spectral within the small veins
Collaterals
how does a LE thrombus migrate?
Superiorly through the leg
Calf > popliteal > SFV > CFV > CIV
IVC
Heart
Right atrium > Right ventricle > Pulmonary artery
Lung = Pulmonary Embolism
what is
hyperechoic thrombus adhered to wall, low risk for emboli
small, contracted vein with collaterals
collateralization - around SFV occlusion, across pelvis for CI
fibrous cord on physical exam
Deep venous insufficiency often secondary to DVT - post-thrombotic syndrome
crhonic DVT (2D)
if thrombus is discovered in the LE what should one do to follow up?
continue proximal to evaluate for thrombus in CI veins and IVC
image below - IVC thrombus seen in long and trans
what prevents LE thrombus from reaching the rt atrium of the heart and eventually the lungs in the form of a pulmonary embolism?
IVC filter
where are IVC filters usually places?
how are they visualized?
what types are there?
inferior to the renal veins
US and xray
greenfield, birds nest, vena tech, trapease
what are these examples of?
Amplatz filter
Gunther Tulip filter
Antheor filter
Tempofilter
Gunther temporary filter
new IVC filters to incl temp and retrievable filters.
how can you tell these are filters?
bright hyperechoic structures followed by shadowing and through transmission
what is a common sequeli to DVT?
edema.
what is excessive fluid in interstitial space that inhibits imaging of vessels deep
edema
other types of pathology
Heart failure
Baker’s cyst
popliteal aneurysm
lymphadenopathy
pseudoaneurysm
what LE disease can be a symptom of heart failure?
what do you see sonographically?
bilateral lower extremity edema – often confused for DVT syptoms but
no DVT, dilated veins due to hypertension and pulsatile venous flow
what is most commonly in patients w/ heart failure or AVF?
Pulsatile flow
High right heart pressure is reflected down IVC to lower extremities
Usually iatrogenic from catheter placement or surgery
this exam was ordered for bilater lower extremilty edema to r/o DVT. what can you see?
bilaterally pulsatile, suggestive of CHF
what is complex synovial fluid collection posterior knee
that has No flow
Risks Arthritis, Trauma
baker’s cyst
what might be a dilated artery post knee >8mm w/ Flow in it
what should u do next?
popliteal aneurysm
Evaluate other popliteal
Evaluate aorta
what is oval with hypoechoic with hyperechoic center
adjacent to vessel
usually in groin
and secondary to infection – cellulitis
lymphadenopathy
what is a hole in the artery with leaking blood
Usually secondary to catheterization
Can also occur post surgically with grafts
pseudoaneurysm
what is this?
acute DVT
what can you note about these 2 acute DVT’s
1st on eis filling defect w/ color – partial thrombus, 2nd is lack of filling in PT veins.
