Vascular - Questions

Question 1

Describe the findings:

Answer 1

• Duplex evaluation of a patient with an aortic endovascular graft
• B-Mode image showing
  
  • a portion of the residual aneurysm sac anteror to the graft device
  • B-Mode evaluation suggests the possibility of Type II endoleak
• Sac dimension have remained unchanged

Question 2

Describe the findings:

Answer 2

B-Mode evaluation suggests the possibility of Type II endoleak

• echolucent region seen in the residual aneurysm sac raises the suspicion of endoleak in an endograft evaluation undertaken beyond the early post-placement period
• Type II endoleak
  
  • originates from retrograde flow through a branch vessel, would be the most likely source, considering that the echolucent area is located along the body of the graft and is not close to either end of the graft

Question 3

Describe Type I endoleak

Answer 3

caused by dysfunction at the proximal or distal attachment sites of the endograft

Question 4

Describe Type II Endoleak

Answer 4

originates from retrograde flow through a branch vessel, would be the most likely source, considering that the echolucent area is located along the body of the graft and is not close to either end of the graft

Question 5

Describe the findings:

Answer 5

Brachial artery-to-Axillary vein PTFE dialysis graft

• no flow demonstrated
• forward, reversed, and aliased flow patterns are noted in the axillary vein (arrow) and a venous branch at the anastomotic site

Question 6

Describe the findings:

• Popliteal pain and leg swelling

Answer 6

ruptured Baker’s cyst

• triangular edge (fluid tracks down tissue)
• location
• cystic quality

Question 7

Describe the findings:

• 63 year old female with LLE swelling
• PMH: HTN, Non-smoker, Non-diabetic
• All LLE veins found to be fully compressible

Answer 7

No DVT - abnormal venous Doppler signal suggestive of outflow obstruction

• fully compressible vessels –> no DVT
• continuous signal –> outflow obstruction

***Iliac vein being compressed by pelvic mass

Question 8

Describe the findings and diagnosis:

• 38 yo male with right calf pain x 4 days
• No significant swelling
• Healthy and active
• No associated risk factors

Answer 8

Hematoma

• skeletal muscle injury with hematoma

Question 9

Describe the findings and diagnosis:

• 48 year old male presents with LUE swelling
• PMH: chronic renal failure and muliple prior UE venous catheters

Answer 9

Chronic partial thrombus (residual venous thrombosis)

• abnormal doppler signals and intraluminal echogenecity

Question 10

Describe the findings and diagnosis:

• 51 year old male presents with LUE swelling and multiple prior hospitalizations
• PMH: DM and ESRD on HD

Answer 10

Retrograde flow in jugular vein likely associated with brachiocephalic vein obstruction

Question 11

Describe the findings and diagnosis:

• 40 year old male presents with bilateral varicosities
• PMH: non-smoker, no h/o DVT or superficial thrombophlebitis

Answer 11

Significant venous reflux observed in GSV

• Negative doppler shift (above baseline) is flow toward the heart ~ 1.25s
• Positive flow (below baseline) is flow back towards the feet ~ several seconds

Question 12

Which direction is flow moving in this color Doppler image?

Answer 12

<— (Right-to-Left)

• determining flow direction requires assessing angle formed between the beam steering direction and the direction of flow
• color box was not steered / angle of insonification very close to 90 degrees
• Vessel is slightly angled (toward/away from transducer) –> apparent change in flow is not because the direction of flow is really changing but rather as a result of change in Doppler angle (greater/less than 90 degrees)