Diagnostic ultrasound ( PDFDrive )

CHAPTER 27 Peripheral Vessels 983
1. Transverse gray-scale image at rest and with compression, or
a cine clip of the compression maneuver, of the saphenofemoral
junction, CFV, FV (at minimum proximal and distal), and PV.
2. Longitudinal color Doppler with spectral waveform
analysis.
a. CFV at the level of the saphenofemoral junction and distal
portions. If only a unilateral examination is requested, the
contralateral CFV is also evaluated.
b. PV at a minimum. Consider recording FV as well.
c. A separate compression image of the profunda femoris
vein at the bifurcation with the FV is not typically obtained,
but patency is evaluated on the longitudinal color and
spectral Doppler waveform of the CFV bifurcation into
the proximal FV and profunda femoris vein.
d. If a thrombus is seen in the CFV, the most proximal extent
of thrombus should be demonstrated with inclusion of
the external iliac veins and IVC in the evaluation.
e. Document additional musculoskeletal indings (such as
popliteal cyst, knee joint efusion, or hematoma if present
in the region being evaluated).
Acute Deep Venous Thrombosis
here are four indings of acute venous thrombosis: (1) intraluminal
material that is deformable during compression, (2)
dilation of the vein, (3) smooth intraluminal material, and (4)
free tail loating proximally from the attachment of the clot on
the vein wall. 85 he classic gray-scale indings of acute DVT
are noncompressibility of the vessel with direct visualization of
the thrombus. With complete acute vein thrombosis, the vein
will typically enlarge. hrombi may completely or partially
occlude the lumen, may be adherent to the wall, or may be
free loating (Fig. 27.26, Video 27.11). Compression ultrasound
for DVT has been shown to have 95% accuracy with 98%
speciicity. 86
A
B
C
D
FIG. 27.26 Acute Deep Venous Thrombosis (DVT). (A) Acute common femoral vein (CFV) thrombus: Compression image in the transverse
plane shows acute CFV thrombus. Note that the vein (arrows) is larger than the adjacent artery (A). (B) Longitudinal color Doppler image in the
same patient shows acute nearly occlusive common femoral vein thrombus with little low. See also Video 27.11. (C) Longitudinal image of acute
DVT in the profunda femoris vein (*), with nonocclusive extension into the CFV (arrow), and a small amount of thrombus in the femoral vein as
well. (D) Transverse color image of acute popliteal vein DVT, with expansion of the vein (arrow) relative to the popliteal artery (A).