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US review March 9, 2011. Rule out DVT If the vein completely compresses there is no underlying clot.

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Presentation on theme: "US review March 9, 2011. Rule out DVT If the vein completely compresses there is no underlying clot."— Presentation transcript:

1 US review March 9, 2011

2 Rule out DVT

3 If the vein completely compresses there is no underlying clot.

4 clot no clot

5 Linear Array Probe (5-10 mHz)

6 Patient reclines at 45 o Hip externally rotated

7 Note: SFV – superficial femoral vein is a deep vein!

8

9 Just 2 key areas to compress

10 Our protocol: 4 compression clips CF-saph bifurcation pop trifurcation

11 A normal exam:

12 Clip #1 CF-saph

13 CFV – G. Saphenous Junction

14 Clip #2 bifurcation

15 Bifurcation: SFV and DFV

16 Clip #3 pop

17 Pop V

18 Clip #4 trifurcation

19 trifurcation: pop divides

20 Some clots:

21 DVT in CFV

22 Clip: partially occlusive DVT

23

24 movie: mobile DVT

25 movie: DVT in CFV

26 Movie: DVT in pop

27 Chronic DVTs look different

28 Chronic DVT –shrunken –fibrotic (hyperechoic) –collaterals –recanalized

29 clip: lymph node

30 The exam is simple!

31 Stuff you dont have to know:

32 the mid-thigh the calf Doppler You can skip:

33 mid-thigh: SFV

34 Calf veins: OK to skip

35 Calf DVTs - Unreliable to diagnose: < 70% sensitivity - Unclear significance: 75% resolve without treatment

36 But what if you find a calf DVT? Plan A: anticoagulate Plan B: ASA only. Monitor for extension (Not all calf veins are equally important)

37 Clip: calf veins

38 Is Doppler needed? No. Compression is sufficient. Color can sometimes help identify vessels. Doppler can give false normals: eg non-occlusive DVT has normal augmentation.

39 Doppler flow info: Augmentation: - squeeze the calf and blood rushes past the probe - implies no obstruction between calf and probe Respiratory phasicity: - implies no obstruction up in pelvis - flow stops on inhale, goes on exhale

40 Venous flow (note respirations)

41 phasic flow and augmentation

42 What is duplex? 2 modalities together: U/S + Doppler

43 Quiz!

44 A B C

45 A C D B

46 A B

47 Where on the leg are we?

48 The End


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