URR Venous Thrombosis

Question 1

most common point of thrombosis origination

Answer 1

soleal sinuses of the calf

Question 2

deep vein thrombosis usually originates where?

Answer 2

in the area of the valves

Question 3

25% of calf vein thrombosis worsens and extends where?

Answer 3

into the pop V

Question 4

what is aggressive treatment for deep vein thrombosis

Answer 4

-bedrest
-lovenox
-IV heparin
-coumadin therapy for 6-12 months after

Question 5

what is may thurner syndrome?

Answer 5

-AKA iliac compression syndrome
-left leg DVT due to the left common iliac coursing under the right common iliac artery
-right CIA can cause extrinsic pressure on the left CIV, which can cause thrombus formation

Question 6

reason for false positive results with CW?

Answer 6

-extrinsic compression closing the vein (bakers cyst, pelvic mass, pregnant uterus)
-significant arterial disease reducing inflow which reduces venous outflow
-improper angle of insonation (perpendicular to flow) causes no flow to be displayed

Question 7

continuous flow in otherwise normal vein means what

Answer 7

prox obstruction

Question 8

prox to a DVT, flow may be what?

Answer 8

very slow and visible on 2D imaging
-color doppler will demonstrate reduced or absent flow

Question 9

if PW doppler flow pattern is detected with partial thrombosis, flow will be

Answer 9

continuous with no response to respiration/augmentation

Question 10

what will veins looks like distal to an acute occlusive thrombosis

Answer 10

dilated and demonstrate continuous flow
-continuous flow in otherwise normal vein = prox obstruction

Question 11

DVT in the deep system forces any remaining flow to other areas of lower pressure. Where does it go?

Answer 11

perforators
-flow exits the deep system through the perforators to try and “escape” into the patent superficial system

Question 12

occlusive deep vein thrombus can lead to what kind of flow in the superficial system?

Answer 12

spontaneous continuous flow, if the GSV is the only outflow path for the venous blood, flow in the superficial system will increase
-if flow in the GSV of the unaffected leg is non-spontaneous and low velocity but the GSV of the affected leg demonstrates spontaneous continuous flow, this can indicated occlusive disease of affected leg

Question 13

acute DVT most commonly occludes the vein with no

Answer 13

residual flow seen with color doppler

Question 14

acute DVT is typically totally occlusive with no

Answer 14

flow detected on PW doppler

Question 15

what is the rouleaux formation

Answer 15

RBCs appear lined up or stacked in rolls similar to coin rolls from your bank

Question 16

rate this thrombosis:
-hypoechoic thrombus not totally occluding vein that is only partially compressible
-flow is able to move through vessel but loses the phasicity, more continuous
-recanalization can lead to the formation of a free floating tail of thrombus; patient will be placed on blood thinners or continue to take them to reduce the risk of embolism as the thrombus atrophies

Answer 16

partial thrombosis

Question 17

rate this thrombosis:
-chronic swelling/edema, brown/blue discoloration, varicose veins, feeling of fullness or heaviness in legs, wet ulcer formation
-thrombus atrophies and fibrosis occurs
-adheres to vein wall causing fibrosis, rigidity and increased echogenicity
-vein is partially compressible with non-pliable thrombus within the lumen
-can cause valve damage (post-phlebitic syndrome)
-more echogenic than acute thrombus
-vein normal sized, not dilated like acute thrombosis
-doppler exam usually demonstrates continuous flow

Answer 17

chronic DVT

Question 18

what is superficial phlebitis and thrombophlebitis

Answer 18

-inflammation of the vein walls w/o or w/ thrombus
-pain, swelling, reddening along affected vein

Question 19

what is SVT

Answer 19

-thrombosis of the superficial vein of the lower extrem
-usually related to valvular insufficiency and/or patient inactivity
-may indicate DVT
-diagnosis usually made clinically
-painful, palpable cord
-treated less aggressively; anti-inflammatory drugs, support stockings, warm compress, limb elevation
-only 20% causes of thrombosis completely resolve, therefore chronic superficial thrombosis does occur

Question 20

increased use of central venous catheters means what

Answer 20

increased UE DVT/SVT

Question 21

facial swelling and chest wall varices can indicate what?

Answer 21

SVC thrombosis

Question 22

how does acute thrombus look in UE

Answer 22

engorges vein, hypoechoic

Question 23

chronic thrombus looks how in the UE

Answer 23

atrophied vein, hyperechoic

Question 24

in the uppper extrem how is flow distal to thrombus

Answer 24

continuous

Question 25

paget - schroetter syndrome

Answer 25

-AKA spontaneous effort thrombosis or venous thoracic outlet syndrome
-most common cause of axillary/subclav DVT in the ambulatory patient
-related to the presence of a cervical rib and thoracic outlet syndrome
-higher incidence in the dominant arm, related to repetitive motion

Question 26

SVC syndrome

Answer 26

-progressive venous occlusion of the SVC
-malignancy primary cause
-causes dilitation of the veins in the upper extrem and neck
-IJV dilated bilat, may be visible especially when patient stands
-doppler demonstrates continuous flow in the bilat IJV
-treatement of the malignancy can reduce tumor size and symptoms of the SVC obsctruction

Question 27

what is lemierre syndrome

Answer 27

-refers to thrombophlebitis of the jugular veins w/ oropharyngeal infection, such as pharyngitis/tonsilitis
-duplex eval can demonstrate thrombus w/in the jugular vein or other neck or facial veins

Question 28

complications of extrem venous thrombosis?

Answer 28

-post phlebitic syndrome
-pulmonary embolism
-phlegmasia cerulea dolens
-phlegmasia alba dolens

Question 29

what is post phlebitic syndrome

Answer 29

-DVT has resolved but damage to vein and valves has occured
-most common complication of DVT
-80% patients with DVT will develop insufficiency within 5-10 years
-DVT stretches veins, veins do not return to original shape, valves do not close properly causing reflux
-symptoms include tiredness and heaviness of the legs, swelling

Question 30

what is a pulmonary embolism

Answer 30

-thrombus breaks loose and travels through the heart to the lungs
->90% PE come from lower extrem DVT
-most significant complication of DVT
-can be fatal
-pulmonary angiography preferred method of diagnosis
-V/Q scan (ventilation quotient or ventilation perfusion) is a nuclear medicine exam used to identify PE

Question 31

what is phlegmasia cerulea Dolens?

Answer 31

-extensive thrombosis occluding deep system and superficial system
-markedly reduced arterial inflow caused by marked reduced venous outflow
-severe limb swelling, edema and mottled skin
-cyanosis occurs due to high concentration of deoxygenated blood
-ischemia in entire extrem very painful
-malignancy is the most common triggering factor
-can cause venous gangrene; involves foot and all toes (arterial gangrene usually involves one or two toes)
-usually treated with clot lysing drugs like streptokinase

Question 32

what is phlegmasia alba dolens

Answer 32

-extensive thrombosis occluding deep system, but the superficial venous system remains patent
-causes mild reduction in arterial inflow
-acute onset of swelling, pallor, and pain
-swelling helps differentiate from an acute arterial occlusion
-pregnancy is the most common triggering factor
-usually treated with clot lysing drugs like streptokinase

Question 33

differential diagnoses for DVT

Answer 33

-muscle strain
-leg injury
-muscle tear
-bakers cyst
-cellulitis
-lymphangitis
-heart failure
-extrinsic compression
-chronic insufficiency
-CHF

Question 34

what is cellulitis

Answer 34

-common bacterial infection of the skin
-causes skin reddening and warmth in affected area
-edema can develop in response to the inflammation
-lymph nodes may enlarge in response to any type of infection

Question 35

what is a bakers cyst?

Answer 35

-encapsulated synovial fluid collection in the medial pop fossa
-measure length, width, and height
-may have septations and or debris
-caused by chronic joint dysfunction
-gastrocnemius semimembranous bursa most commonly affected
-differential diagnoses include hematoma and abscess, patient hx becomes crucial to diagnosis
-can mimic partial thrombosis by causing continuous venous flow and limited augmentation response to pop vein