1. Deep Vein Thrombosis (DVT) Formation of a clot within a vein Occurs when there is i) venous stasis ii)Vessel injury ii)hyper coaguability

2. References Myer, Kenneth A. and Amy Clough. Making Sense Of Vascular Ultrasound: A Hands-on Guide. London: Arnold, 2004 Allan, Paul L.P. Clinical Doppler Ultrasound [Oxford]: Churchill Livingstone/ Elsevier, 2006 2) http://sonoworld.com/Client/Lectures/LectureDe tails.aspx?Id=973&Sequence=1 Online evidence accessed 1/10/13 Bruno, G. L. 2013. Looking beyond the routine DVT scan. Soundeffects 1

3. Predisposing factors VENOUS STASIS Prolonged periods of inactivity Limb immobilisation due to fracture Post surgery immobilisation Cancer VESSEL INJURY Causing non functioning of valves HYPERCOAGUABILITY Congenital thropmophilia

4. Presentation Usually asymptomatic Calf swelling Pain, worse when flexing the foot redness

5. Ultrasound appearances Normal veins Anechoic lumen Colour doppler fills the whole lumen Compressibility Phasic flow with respiration Very few or no collateral channels Vein with thrombus Static echoes within the lumen Incomplete or absent colour within lumen on colour doppler Partial or non compressibility Loss of spontaneous phasic flow with respiration Increased flow collateral vessels

7. When there is a thrombus Image of non compressible vein Its location on the leg in relation to a landmark. ( Groin crease, knee crease?) Is it in a deep or superficial vein? If in superficial vein, its distance from the junction with the deep vein

8. Thrombus

9. Colour Flow Doppler Showing DVT Absence of colour flow in the peroneal branches

10. The Report Size and position of thrombus Distance of thrombus from either groin or knee Age thrombus