DVT ultrasound: Difference between revisions
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==Background== | ==Background== | ||
* | *Bedside ultrasound can be used to conduct 2-point or 3-point compression testing on lower extremity vasculature to assess for DVT | ||
* | *Intended to be rapid, limited, but revealing most clinically significant DVTs | ||
*Amongst ED providers, there is a sensitivity of 95% and specificity of 96%<ref>Burnside P, Brown M, and Kline J. Systematic review of emergency physician-performed ultrasonography for lower-extremity deep vein thrombosis. Acad Emerg Med. 2008; 15:493–498.</ref> | |||
==Technique== | ==Technique== | ||
===Sites of Compression for 3-Point Evaluation=== | |||
[[File:Compression of Lower Extremity Veins.png|200px]] | |||
#Common Femoral Vein | |||
#Saphenofemoral Junction | |||
#Popliteal Vein | |||
===Steps=== | |||
#Select transducer | #Select transducer | ||
#*Linear array vascular probe 6–10 MHz | #*Linear array vascular probe 6–10 MHz | ||
#* | #*For morbidly obese patients, consider abdominal probe | ||
#Common Femoral Vein and Saphenofemoral Junction | |||
#Common Femoral Vein | |||
#*Patient positioning | #*Patient positioning | ||
#**Reverse | #**Reverse Trendelenburg or semi-sitting with 30 degrees of hip flexion | ||
#**Mild external rotation (30 degrees) hip | #**Mild external rotation (30 degrees) hip | ||
#*Probe at medial inguinal crease | #*Probe at medial inguinal crease | ||
#*Apply compression every centimeter | #*Apply generous compression every centimeter | ||
#*Continue distal to 1-2cm beyond bifurcation of the common femoral vein | #*Continue distal to 1-2cm beyond bifurcation of the common femoral vein | ||
#Popliteal vein | #Popliteal vein | ||
#*Patient positioning | #*Patient positioning | ||
#**Prone, decubitus position, or seated on edge of gurney | #**Prone, decubitus position, or seated on edge of gurney | ||
#**Knee flexed 10–30 degree | #**Knee flexed 10–30 degree | ||
#**Reverse | #**Reverse Trendelenburg | ||
#* | #*Apply generous compression over the popliteal vessals | ||
# | #*Vein usually superficial to artery | ||
==Findings== | |||
*Each segment of vein identified must be assess as compressible and noncompressible | |||
**Touching of the anterior and posterior walls indicates a normal exam | |||
**No touching with pressures sufficient to deform the artery indicates DVT | |||
==Images== | |||
===Normal=== | |||
[[File:Compression of Femoral Vein.png]] | |||
[[File:Popliteal artery and vein.png]] | |||
===Abnormal=== | |||
[[File:DVT in the Femoral Vein.png]] | |||
==Pearls and Pitfalls== | |||
*Arteries are the thick walled and more circular vessels identified | |||
*Doppler flow can be used to identify different directions of flow in vessels and to identify no vascular structures | |||
*Noncompressible vein may be mistaken for an artery, leading to a false negative result | |||
*An artery may be mistaken for a non-compressible vein, leading to a false positive result | |||
*Lymph nodes may be confused with noncompressible vein and if found, can be identified by moving up or down 1 cm | |||
==Documentation== | |||
===Normal Exam=== | |||
A bedside ultrasound was conducted to assess for DVT with clinical indications of edema and pain. The extremity was assessed at 3 locations – common femoral vein, saphenofemoral junction, and the popliteal vein. Sequential compressions at these sites showed fully compressible veins. No sonographic evidence of DVT at these sites. | |||
===Abnormal Exam=== | |||
A bedside ultrasound was conducted to assess for DVT with clinical indications of edema and pain. The extremity was assessed at 3 locations – common femoral vein, saphenofemoral junction, and the popliteal vein. Sequential compressions at these sites showed a noncompressible popliteal vein. DVT is present at the level of the popliteal vein. | |||
==Video== | |||
{{#widget:YouTube|id= FHerMNhCR54}} | |||
==External Links== | |||
*[http://www.acep.org/Clinical---Practice-Management/Focus-On--Emergency-Ultrasound-For-Deep-Vein-Thrombosis/ ACEP – Focus On Emergency Ultrasound for DVT] | |||
*[http://www.fpnotebook.com/hemeonc/Rad/FcsdLwrExtrmtyVnsUltrsnd.htm Focused Lower Extremity Venous Ultrasound] | |||
==See Also== | ==See Also== | ||
*[[Ultrasound (Main)]] | *[[Ultrasound (Main)]] | ||
*[[DVT (Deep Venous Thrombosis)]] | *[[DVT (Deep Venous Thrombosis)]] | ||
*[[Pulmonary Embolism]] | |||
*[[Paget-Schroetter Syndrome]] | *[[Paget-Schroetter Syndrome]] | ||
== | ==References== | ||
<references/> | |||
[[Category:Ultrasound]] | |||
[[Category:Rads]] | [[Category:Rads]] | ||
[[Category:Vascular]] | [[Category:Vascular]] | ||
Revision as of 17:11, 1 November 2015
Background
- Bedside ultrasound can be used to conduct 2-point or 3-point compression testing on lower extremity vasculature to assess for DVT
- Intended to be rapid, limited, but revealing most clinically significant DVTs
- Amongst ED providers, there is a sensitivity of 95% and specificity of 96%[1]
Technique
Sites of Compression for 3-Point Evaluation
- Common Femoral Vein
- Saphenofemoral Junction
- Popliteal Vein
Steps
- Select transducer
- Linear array vascular probe 6–10 MHz
- For morbidly obese patients, consider abdominal probe
- Common Femoral Vein and Saphenofemoral Junction
- Patient positioning
- Reverse Trendelenburg or semi-sitting with 30 degrees of hip flexion
- Mild external rotation (30 degrees) hip
- Probe at medial inguinal crease
- Apply generous compression every centimeter
- Continue distal to 1-2cm beyond bifurcation of the common femoral vein
- Patient positioning
- Popliteal vein
- Patient positioning
- Prone, decubitus position, or seated on edge of gurney
- Knee flexed 10–30 degree
- Reverse Trendelenburg
- Apply generous compression over the popliteal vessals
- Vein usually superficial to artery
- Patient positioning
Findings
- Each segment of vein identified must be assess as compressible and noncompressible
- Touching of the anterior and posterior walls indicates a normal exam
- No touching with pressures sufficient to deform the artery indicates DVT
Images
Normal
Abnormal
Pearls and Pitfalls
- Arteries are the thick walled and more circular vessels identified
- Doppler flow can be used to identify different directions of flow in vessels and to identify no vascular structures
- Noncompressible vein may be mistaken for an artery, leading to a false negative result
- An artery may be mistaken for a non-compressible vein, leading to a false positive result
- Lymph nodes may be confused with noncompressible vein and if found, can be identified by moving up or down 1 cm
Documentation
Normal Exam
A bedside ultrasound was conducted to assess for DVT with clinical indications of edema and pain. The extremity was assessed at 3 locations – common femoral vein, saphenofemoral junction, and the popliteal vein. Sequential compressions at these sites showed fully compressible veins. No sonographic evidence of DVT at these sites.
Abnormal Exam
A bedside ultrasound was conducted to assess for DVT with clinical indications of edema and pain. The extremity was assessed at 3 locations – common femoral vein, saphenofemoral junction, and the popliteal vein. Sequential compressions at these sites showed a noncompressible popliteal vein. DVT is present at the level of the popliteal vein.
Video
{{#widget:YouTube|id= FHerMNhCR54}}
External Links
See Also
References
- ↑ Burnside P, Brown M, and Kline J. Systematic review of emergency physician-performed ultrasonography for lower-extremity deep vein thrombosis. Acad Emerg Med. 2008; 15:493–498.