Diagnostic ultrasound ( PDFDrive )

CHAPTER 27 Peripheral Vessels 995
A
B
C
FIG. 27.46 Thrombus Associated With Central Lines. (A)
Transverse image shows acute thrombus around peripherally inserted
central catheter (PICC) line in the basilic vein. Thrombus completely
occludes noncompressible vein. (B) Acute thrombus around PICC
catheter in the basilic vein. No low seen on duplex Doppler in the
longitudinal plane. (C) Longitudinal image of the internal jugular vein
shows a moderate amount of thrombus around a central line in
another patient. See also Video 27.23 and Video 27.24.
A
B
FIG. 27.47 Collateral Formation in the Upper Extremity After Deep Venous Thrombosis (DVT). (A) Transverse images of many serpiginous
veins (*) in the region of the chronically occluded proximal internal jugular vein near the base of the neck. C, Carotid. (B) Longitudinal duplex Doppler
image shows no spectral low in the small, occluded distal internal jugular vein.
An excellent example is demonstration of only one brachial vein
because of chronic scarring from prior DVT of the paired brachial
veins 116 (Fig. 27.48).
Potential Pitfalls
Upper extremity pitfalls to avoid include the following 117-119 :
1. Axillary versus cephalic vein: he axillary vein of the deep
venous system empties into the subclavian vein. he cephalic
vein of the supericial venous system empties into the axillary
vein and will not have an adjacent artery along its course.
Access to the axilla is generally improved by bending the
patient’s elbow and placing the hand near the patient’s head,
with an outstretched arm. Excessive abduction may alter the
venous waveform, falsely suggesting a more central venous
stenosis or obstruction; however, this will resolve with change
in position.