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DMST 265 Vascular Sonography 1 > Module 5: Acute Venous pathophysiology > Flashcards

Module 5: Acute Venous pathophysiology Flashcards

1
Q

What is a D-Dimer Positive?

A

Blood test that detects a certain protein in the presence of some sort of blood clot.

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2
Q

DVT occurs in about how many Canadians each year?

A

200,000

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3
Q

Pulmonary embolism is the leading cause of what death associated with which party?

A

Maternal women with child birth

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4
Q

A women’s risk of developing Venous thromboembolism (VTE) is how much greater if pregnant?

A

Six times

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5
Q

Pulmonary embolism causes more deaths annually in North America than what?

A
  1. Breast cancer
  2. AIDs
  3. Highway fatalities
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6
Q

Fetal Pulmonary embolism may be the most common preventative cause of ________ in ____________?

A

Hospital death in North America

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7
Q

Approximately how many patients are hospitalized each year for DVT in Canada each year?

A

60,000

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8
Q

What is the most common reason we scan extremity veins?

A

DVT

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9
Q

How much DVT is clinically diagnosed diagnose?

A

50%

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10
Q

What are some complications of DVT?

A
  1. Pulmonary embolism
  2. Chronic venous insufficiency (CVI)
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11
Q

How much pulmonary embolism originate in LE?

A

80%

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12
Q

If untreated what is the mortality rate of pulmonary embolism?

A

30%

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13
Q

Venous diseases can be what two things?

A

acute or chronic

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14
Q

Venous disease can effect what systems?

A

Both deep or superficial systems

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15
Q

The venous system can also be effected by what?

A

Non- venous pathologies

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16
Q

What are some underlying risk factors DVTs?

A
  1. Genetics
  2. Acquired - more common
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17
Q

What are some genetic factors for DVTs?

A
  1. Gender
  2. Race
  3. Antithrombin deficiency
  4. Fact V Leiden mutation
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18
Q

Acquired factors can be categorized into what system?

A

Virchow’s Triad

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19
Q

What is Virchow’s Triad?

A
  1. Stasis
  2. Injury
  3. Hypercoagulability
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20
Q

What is the most common factor for LE DVT?

A

Venous stasis

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21
Q

What are some reasons for Venous stasis?

A
  1. Immobility
  2. Congestive heart failure
  3. Obesity
  4. Pregnancy (vein compression L>R)
  5. Surgery (leg or hip example)
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22
Q

How would we get DVT from injuries?

A

Trauma to vessels, Like infection or HTN

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23
Q

What is the most common factor for UE DVT?

A

Central lines like peripherally inserted central catheter (PICC)

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24
Q

What is hypercoagulability?

A

The clotting ability of blood is increased

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25
Q

What are some reasons for Hypercoagulability?

A
  1. Pregnancy
  2. Cancer
  3. Estrogen intake (BCP, HRT)
  4. Genetic blood factors
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26
Q

What are some questions we for patient history for DVT?

A
  1. Previous DVT or family history
  2. Trauma?
  3. Surgery?
  4. Bed rest > 4 days
  5. Medications (BCP/HRT)
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27
Q

What is the difference between signs and symptoms?

A

Symptoms are patient recorded and signs are things we can see
Symptom could be something like pain, we can’t see pain

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28
Q

What are some common acute signs of onset for DVT?

A
  1. Pain
  2. Swelling (edema)
  3. Redness/ erythema
  4. Skin warm/ hot to touch
  5. Persistent pain (positive Homans sign)
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29
Q

What are some Symptoms of Pulmonary embolism?

A
  1. SOB
  2. Chest pain
  3. Hemoptysis
  4. Increased heart rate/ respiratory rate

C his

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30
Q

What are less common signs and symptoms for DVT?

A
  1. Ulceration (gaiter area, medical malleoulus) , shallow and round
  2. Discoloration in the gaiter area
  3. Varicose veins
  4. Pallor (phegmasia alba dolens) or getting white
  5. Cyanosis (phlegmasia cerulea dolens) or getting blue
  6. Positive D-timer test result

C pup VD

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31
Q

D-dimer test looks for what?

A

The presence of breakdown products of linked fibrin

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32
Q

D-dimers are very how sensitive to clots, and is it specific to DVTs?

A

Very sensitive 95%, but not specific to DVTs

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33
Q

For DVTs false positives occur due to what?

A
  1. Trauma
  2. Surgeries
  3. Pregnancy
  4. Malignancy
  5. Liver
  6. Kidney disease

PMS TLK

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34
Q

If there is a negative D-dimer test how likely is a DVT?

A

Unlikely

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35
Q

What is Well’s score?

A

Clinical assessment that estimates the DVT probabilities

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36
Q

What is the reported scores for Well’s score?

A

Low - 0
Intermediate - 1 or 2
High - 3

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37
Q

How is the Well’s score used for PE?

A
  1. Clinical assessment
  2. Positive criterion is a given number value
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38
Q

What is the PE well’s scoring system?

A

Low probability (<2)
Intermediate (2 to 6)
High (>6)

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39
Q

For thrombus formation where does it usually begin?

A

Soleal calf veins or the valve cusps due to stasis

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40
Q

What is thrombus formation?

A
  1. Red blood cells aggregate and cause fibrin formation and adheres to vessels walls
    this induces further thrombosis which propagates along the vessel lumen
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41
Q

Acute stage of thrombus formation is within what time frame?

A

First 14 days after thrombus forms

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42
Q

What are other sites for thrombus?

A
  1. Muscular veins (gastrocnemius or soleal sinus)
  2. Valves sites
  3. Venous confluence
  4. Perforators
  5. Deep venous system or superficial system

Vm Vpd

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43
Q

What is the most common site for Calf vein DVT?

A

Soleal sinus

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44
Q

What is the current approaches to treatment for DVT?

A
  1. Surveillance with duplex US to check for propagation to larger veins
  2. Therapeutic anticoagulation for 6 weeks
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45
Q

Between a fem pop DVT and a calf DVT which is more serious? why?

A

Fem- pop DVT because of the higher risk of PE

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46
Q

For fem-pop DVTs what initial test is performed?

A

Duplex sonography initial test

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47
Q

What is the most common treatment for Fem-Pop DVT?

A

Anticoagulation therapy

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48
Q

Imaging the Iliac veins can be challenging and success is dependent on what?

A

Patients body habitus

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49
Q

For Iliac DVTs doppler signals can give what?

A

Indirect information

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50
Q

For iliac DVT we should compare what things and assess what?

A

We should compare bilateral CFV waveforms and assess the IVC

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51
Q

How do we confirm Iliac DVT?

A

Venography

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52
Q

What are UE DVTs a result of?

A

Central venous catheters

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53
Q

Besides Central venous catheters, what can UE DVT be a result of?

A
  1. Mediastinal lymphoma
  2. Previous radiation therapy
  3. Trauma or surgery to the area
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54
Q

When can an acute DVT be first seen?

A

First 14 days

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55
Q

Acute thrombus can look how?

A

Anechoic to hypoechoic and enlarges the vessel slightly
There will be incomplete compression of the lumen with the transducer

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56
Q

For a sub-acute DVT when would it present and what would it look like?

A

1 to 2 months old and can be slightly more echogenic and retracts in size

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57
Q

When the DVT is distal to where you scan the waveform can show what?

A

Reduced or absent augment

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58
Q

Collateralization is another sign of what?

A

DVT

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59
Q

Collaterals are what?

A

Accessory vessels that reroute flow around an obstruction.

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60
Q

Collaterals may occur rapidly in the presence of what?

A

DVT and may be readily seen

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61
Q

What are some Rare DVT conditions?

A
  1. May-Thurber syndrome
  2. Pages- Schreotter syndrome
  3. Phlegmasia Alba Dolens
  4. Phlegmasia cerulean dolens
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62
Q

What a some rare conditions of DVT?

A
  1. May- Thurner syndrome
  2. Page- Schroetter Syndrome
  3. Phlegmasia Alba Dolens
  4. Phlegmasia Cerulean Dolens
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63
Q

What is another name for May- Thurber Sydrome?

A

Iliac vein compression syndrome

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64
Q

What is May-Thurner syndrome?

A

Result of an anatomical variant of an overriding RT CIA compressing the LT CIV against the 5th Lumbar vertebra

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65
Q

Who is the most common demographic for May-Thurber syndrome?

A

Young females in their 20s to 40s

66
Q

How does May-Thurner syndrome present like?

A

Left leg pain and swelling

67
Q

What is the most common demographic for May-Thurner Syndrome?

A

Young females in their 20s and 40s

68
Q

How do we diagnose May- Thurner Syndrome?

A

Venography with pressure measurements is the gold standard for diagnosis

69
Q

What may we see during May-Thurner syndrome at the vein site in terms of flow pattern?

A

May see a narrowing with a jet at the site of the stenosis or a continuous flow pattern distal

70
Q

What is another name for Paget- Schroetter Syndrome?

A

Spontaneous effort Thrombosis

71
Q

Where is Paget-Schroetter syndrome most commonly seen?

A

Axillio- Subclavian thrombosis in ambulatory cancer free population

72
Q

What demographic does Paget- Schroetter syndrome commonly affect?

A

Men, typically in their dominant arm

73
Q

What can Paget-Schroetter syndrome be associated with?

A

Thoracic inlet abnormalities (cervical rib, muscle)

74
Q

What is another name for Phlegmasia Alba Dolens?

A

Painful white inflammation

75
Q

What is Phlegmasia alba dolens?

A

Massive occupation of the major deep venous system

76
Q

Can the blood still drain with Phlegmasia Alba Dolens?

A

Yes through the collaterals

77
Q

Can blood still drain in Phlegmasia Alba Dolen?

A

Yes through the Collaterals

78
Q

During Phlegmasia Alba Dolens what does it look like?

A

Extensive edema with a white discolouration

79
Q

What does Phlegmasia Alba Dolen progress to?

A

Cerulea Dolens

80
Q

What is another name for Phlegmasia Cerulea Dolens?

A

Painful blue inflammation

81
Q

What is Phlegmasia Cerulea Dolens?

A

Occlusion of the major deep venous system

82
Q

What is Phlegmasia Cerulea Doleans?

A

Occlusion of the major deep venous system and the collaterals

83
Q

What does Phlegmasia Cerulea Dolens result in?

A

Reduced arterial flow

84
Q

What does Phlegmasia Cerulea Dolens present with?

A

Massive thigh and calf swelling with a blue discolouration.

85
Q

In Phlegmasia Cerulea Dolens what happens if we leave it untreated?

A

Venous gangrene and massive tissue death

86
Q

Would Phlegmasia Cerulea Dolens be an emergency?

A

It would we a surgical emergency

87
Q

Would Phlegmasia Cerulea Dolens be a emergency?

A

A surgical emergency

88
Q

Treatments for DVTs can be grouped into how many categories?

A

Three

89
Q

What are the three categories for DVT treatment?

A
  1. Prevention (control of the risk factors)
  2. Medical
  3. Surgical
90
Q

How can we prevent a DVT?

A
  1. Control the risk factors
  2. Limit long period of inactivity
  3. Wear support hose elevating legs
  4. Blood tests to test for hypercoagulability states and blood factors remember Virchow’s triad
91
Q

What are some medical treatments for DVT?

A
  1. Anticoagulation therapy
  2. Thrombolytic agent
92
Q

How long will someone be on anticoagulation therapy for medical treatment?

A

3-6 months

93
Q

If a clot is recurrent how long will the a person be on anticoagulation therapy?

A

Life

94
Q

What does Anticoagulation therapy do?

A

Prevent clot propagation

95
Q

Does anticoagulation therapy dissolve the thrombus?

A

Nope

96
Q

What happens during the thrombolytic treatment for DVT?

A

Streptokinase may be injected to dissolve the thrombus

97
Q

When is thrombolytic agents used for DVT?

A

Used when the symptoms are severe

98
Q

What can Thrombolytic Agents lead to?

A

Major bleeding episodes

99
Q

What are some surgical treatments for DVTs?

A
  1. Venous thrombectomy
  2. Bypass grafting
  3. Balloon Venoplasty and stunting
100
Q

When do we do a venous thrombectomy?

A

Patient with impending limb loss (Phlegmasia Cerulea dolens) if a thrombolytic agent does not work.

101
Q

What is bypass grafting?

A

Caval Occulsion

102
Q

When would we use balloon venoplasty and stenting?

A
  1. Chronic iliofemoral DVT
  2. May-Thurner Syndrome
103
Q

What is an IVC filter?

A

An option for patient who cannot be anticoaguated

104
Q

What is superficial thrombophlebitis?

A

As a painful superficial cord and inflammation in the veins

105
Q

For a superficial thrombophlebitis what can ultrasound do?

A

Determine the extent of thrombus

106
Q

Approximately how much of the superficial thrombosis has a concurrent DVT or PE?

A

25%

107
Q

Anticoaguation therapy is indicated if the thrombus is at what level?

A

5cm more in length or is 3 cm of the SFJ.
the same consideration is given to the SSV and popliteal anastomosis

108
Q

What is the treatment for thrombophlebitis?

A
  1. Apply heat to site
  2. Compression stockings
  3. Non- steroidal anti-inflammatory meds
  4. Low molecular weight heparin for 45 days
109
Q

What are some corrective tests for venous thromboembolic disease (VTE)?

A
  1. Venography
  2. CT
  3. Nuclear medicine
  4. MRI
110
Q

A Venography is what?

A

A X-ray taken of the leg where contrast media is injected to outline the veins

111
Q

For Venography the contrast is injected where?

A

Into a large vein in the foot/ankle

112
Q

Venography is a very invasive test and has been largely replaced by what?

A

Ultrasound

113
Q

Some patients are contraindicated for what procedures?

A

Venography contrast

114
Q

What is CTs used for in terms of DVTs?

A

Pulmonary angiogram or CTPA

115
Q

CT is the standard test for what?

A

Pulmonary embolism

116
Q

CTs also require what to be injected?

A

Contrast to be injected into the patient

117
Q

What kind of nuclear medicine test used for DVTs?

A

Ventilation perfusion (V/Q) scan

118
Q

What is the process of the Ventilation-perfusion (V/Q) scan?

A

Ventilation part involves inhaling a radioactive gas to demonstrate the presence of a Pulmonary embolism

119
Q

What does a V/Q scan show?

A

Parts of the lung that are getting oxygen

120
Q

What should the perfusion look like for a V/Q scan?

A

We should look at blood flow to the lung to see if there is diminished flow from clots

121
Q

What is the probability of V/Q scans reporting P/E?

A

High/ moderate/ low probability

122
Q

What is a isotope Venography?

A

A nuclear medicine test where a radioisotope is injected to evaluate peripheral and pulmonary veins

123
Q

What does the Isotope Venography tag?

A

The thrombus

124
Q

How often is isotope Venography used?

A

Infrequently

125
Q

With such vague symptoms, there are many differentials to consider when you scan, name a couple.

A
  1. Bakers cysts
  2. Hematoma
  3. Edema
  4. Lymphedema
  5. Infection
  6. Abscess
  7. Cellulitis
  8. Tumours
  9. Popliteal A aneurysm
126
Q

What is a bakers cyst?

A

Dilation of bursa in the Posteromedial knee

127
Q

What is bakers cysts common with?

A

Degenerative joint disease and rheumatoid arthritis

128
Q

The Baker cysts can extend into what?

A

Muscle planes, and become hemorrhagic or rupture

129
Q

Baker cysts can cause what?

A
  1. Pain
  2. Tenderness
  3. Swelling
130
Q

How might a bakers cyst look?

A

Tear drop shape and may not be visible with the knee extending

131
Q

If we see a bakers cysts what should we do?

A

Measure in three planes and interrogate with colour doppler

132
Q

What causes hematomas?

A

Results of trauma, anticoaguation therapy or vigorous exercise

133
Q

What is the sonographic appearance dependent of for hematomas?

A

Dependent on age of occurrence

134
Q

Where should we scan for hematomas?

A

Where it hurts or where there is a palpable lump

135
Q

If we see a hematoma how should we note it for the rad?

A

Measure in three planes and interrogate with colour doppler

136
Q

What causes soft tissue edema occur?

A

Increased venous pressures

137
Q

What are some examples of things that may cause soft tissue edema?

A
  1. Heart failure
  2. Fluid overload
  3. DVT
  4. Venous obstruction
  5. Presents as leg swelling
138
Q

What is this?

A

Soft tissue edema

139
Q

If CHF is the cause then the edema is what?

A

Bilateral from increased hydrostatic pressure

140
Q

For edemas the patient can present with what?

A

Dyspnea and may have a negative D-dimer

141
Q

If we see an edema what can we do?

A

Use ultrasound to rule out DVT

142
Q

What does the waveform of edemas look?

A

Can be pulsatile

143
Q

What is a lymphedema?

A

obstruction of lymph drainage due to
1. Malignancy
2. Trauma
3. Surgery

144
Q

Where are lymphedemas common?

A

In the calf and upper extremity

145
Q

2/3 of lymphedema cases are what?

A

Unilateral

146
Q

What does lymphedema’s demonstrate?

A

Pitting edema

147
Q

What is the appearance of lymphedema’s?

A

Milky appearance

148
Q

What does an infection- abscess and cellulitis a result of?

A

Bacterial infection

149
Q

What is a abscess?

A

Enclosed collection of pus

150
Q

What is cellulitis?

A

Diffuse collection of fluid within the subcutaneous tissue

151
Q

What May infections cause?

A
  1. Swelling
  2. Erythema
  3. Pain
  4. Tenderness
152
Q

Ultrasound infections to do what/

A

Confirm that the venous system is patent

153
Q

What is adenopathy?

A

Enlarged lymph nodes that can be mistaken for thrombosed veins

154
Q

Adenopathy may cause what?

A

Limb swelling, compression of veins

155
Q

What is a benign lymph node?

A
  1. Ovoid
  2. Wider then tall
  3. Hypoechoic hilum
  4. Less than 1 cm
156
Q

What does a malignant lymph node look like?

A
  1. Rounded shape
  2. Taller than wide
  3. Increased Colour flow
  4. Lose normal architecture
157
Q

What are some examples of tumours?

A
  1. Benign (Lipoma)
  2. Malignant (Sarcoma, Lymphoma)
158
Q

Tumours are usually solid but may have areas of what?

A

Necrosis

159
Q

As a sonographer what should we do if we see a tumour?

A

Interrogate with colour and Doppler

160
Q

What does popliteal aneurysm present with?

A
  1. Lump or pain behind the knee
  2. Dilated arterial wall
  3. Colour flow if patent
  4. Higher risk with AAA
161
Q

What is this an example of?

A

Popliteal Aneurysm

DMST 265 Vascular Sonography 1 (19 decks)

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