Venous Pathology Flashcards
Upper extremity signs and symptoms
Unilateral arm or hand swelling
Superficial palpable cord
Erythema
Pain and tenderness
Facial swelling or dilated chest wall collaterals
Suggestive of superior vena cava thrombosis
Upper extremity patients may present with….
Indwelling catheters or history of venous catheters
Asymptomatic patients
May be examined before central catheter placement or prior to pacemaker placement
Upper extremity veins may also be evaluated in patients
Suspected of pulmonary embolism
PE symptoms
chest pain, tachypnea, or tachycardia
Virchow’s Triad
Venous stasis
Hypercoagulability
Vessel wall injury
Upper extremity thrombosis more common due to
Injury to vessels wall
More frequent introduction of needles and catheters into arm veins
what veins are commonly used for indwelling catheters
Subclavian and internal jugular veins
May be associated with upper extremity thrombosis
PICCS may also be
A cause of thrombosis
Catheter is inserted through basilic or cephalic vein then positioned near right atrium
Paget-Shrotter syndrome
Venous thrombosis associated with compression of subclavian vein at the thoracic outlet
AKA effort thrombosis
Typical patients are young, athletic, and muscular males
What are risk factors for thrombus
Trauma Immobility or paralysis Prior DVT Recent major surgery Cancer or chemotherapy Family history CHF Pregnancy Oral contraceptives Hypercoagulability Prolonged bed rest
Acute thrombus
Is uniform in texture, with low-level echoes that may be difficult to visualize
- Is soft, or slightly compressible
- Is poorly attached; may sometimes “flap about” within the vessel
- Distends the vessel
Chronic Thrombus
Is heterogeneous, with bright echoes
•Does not compress
•Is rigidly attached
•Tends to contract the vessel and may show a partial recanalization of the vein with a tortuous flow channel with well-developed collateral circulation
Superficial venous thrombus
Diagnosed clinically with a painful superficial cord with surrounding erythema
Venous insufficiency
AKA Reflux Incompetent valves Allows retrograde flow Veins enlarge due to pressure increase Can become infected Postphlebitic syndrome aka postthrombotic syndrome
How can venous insufficiency be tested
Valsalva; competent if flow stops; doppler signal stops
Varicose veins
Damaged valves Leaking venous distention Spider veins Bulging, superficial veins sometimes seen under skin Primary and secondary varicose veins Advanced age, obesity, family hx
How can varicose veins be treated
Stripping, injections, lasers, radiofrequency
Phlegmasia cerulea dolens
“PCD”
Cerulea = Blue
From severe acute dvt
Proximal outflow of limb blocked blood pools becomes blue
Untreated gangrene, phlegmasia alba dolens, limbs amputation, death
When does PCD usually occur
Men more than women
PCD is strongly correlated to
Malignancy
What are risk factors of PCD
hypercoagulable state
venous stasis
contraceptive use
PAD results from
Untreated PCD
Phlegmasia Alba Dolens
“Alba” means white
Results from untreated PCD where massive dvt compresses adjacent artery
Causes artery to vasospasm or constrict
Blood flow to limb decreases turn white
Rare
High amputation and mortality rate
Phlegmasia alba dolens sonographically
artery deformed appearance, low colour Doppler signal, and abnormal arterial waveform
May thurner syndrome
2% to 23% of Le DVT case
Aka iliocaval compression syndrome
Mild to severe
Who is may thurner syndrome seen in
Young women
May thurner syndrome is caused by
Mostly compression left iliac vein between right iliac artery and spine or pelvic brim
what does may thurner syndrome do?
Causes web-like adhesions which occlude vein (also the webs can filter and help prevent PE)
Treated with anticoagulants, therapy stents, and bypass grafts
Differential diagnosis-pain and swelling lower extremities
Popliteal cysts, also known as Baker or synovial cysts
Ruptured popliteal cysts
Pseudoaneurysms, most often related to trauma
Popliteal artery aneurysm
Hematoma and/or muscle injuries (tear or rupture)
Lymphedema, due to obstruction of lymphatic system
Cellulitis
