DVT ultrasound: Difference between revisions
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==Indications== | ==Indications== | ||
*Clinical suspicion of DVT: edema, tenderness over the calf, Homan's sign | *Clinical suspicion of DVT: edema, tenderness over the calf, Homan's sign | ||
*Clinical suspicion of PE: chest pain, | *Clinical suspicion of PE: chest pain, shortness of breath, tachycardia, tachypnea | ||
==Technique== | ==Technique== | ||
| Line 31: | Line 31: | ||
#**Reverse Trendelenburg | #**Reverse Trendelenburg | ||
#*Apply generous compression over the popliteal vessals | #*Apply generous compression over the popliteal vessals | ||
#*Vein usually | #*Vein usually superficial to the artery ('''a'''rtery is '''a'''nterior) | ||
==Findings== | ==Findings== | ||
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===Abnormal=== | ===Abnormal=== | ||
[[File:DVT in the Femoral Vein.png|400px|DVT of the Femoral Vein]] | [[File:DVT in the Femoral Vein.png|400px|DVT of the Femoral Vein]] | ||
[[File:DVT Bowra|thumbnail|Incompressible left Common Femoral Vein<ref>http://www.thepocusatlas.com/soft-tissue-vascular/</ref>]] | |||
==Pearls and Pitfalls== | ==Pearls and Pitfalls== | ||
| Line 51: | Line 52: | ||
*An artery may be mistaken for a non-compressible vein, leading to a false positive 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 | *Lymph nodes may be confused with noncompressible vein and if found, can be identified by moving up or down 1 cm | ||
*Does not rule out calf DVTs | |||
*For a more thorough exam, scan from the saphenofemoral junction down through the adductor canal in addition to the areas described above | |||
*Use a curvilinear probe for obese or edematous patients | |||
*An appropriate amount of pressure gives complete collapse of the vein as well as some (but not full) compression of the adjacent artery.<ref>Kline JA et al. Annals of Emerg Med, 2008. PMID: 18562044</ref> | |||
==Documentation== | ==Documentation== | ||
===Normal Exam=== | ===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. | 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=== | ===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. | 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. | ||
==Clips== | ==Clips== | ||
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[[File:No DVT fem 2.gif]] | [[File:No DVT fem 2.gif]] | ||
[[File:No DVT pop.gif]] | [[File:No DVT pop.gif]] | ||
===Abnormal Study - Incompressible left Common Femoral Vein=== | |||
[[File:DVT Bowra.gif|Incompressible left Common Femoral Vein<ref>http://www.thepocusatlas.com/soft-tissue-vascular/</ref>]] | |||
==External Links== | ==External Links== | ||
| Line 69: | Line 76: | ||
==See Also== | ==See Also== | ||
*[[Ultrasound ( | *[[Ultrasound (ain)]] | ||
*[[ | *[[Deep venous thrombosis]] | ||
*[[Pulmonary | *[[Pulmonary embolism]] | ||
*[[Paget-Schroetter | *[[Paget-Schroetter syndrome]] | ||
==References== | ==References== | ||
Revision as of 18:08, 28 February 2018
Background
- Bedside ultrasound can be used to conduct 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]
Indications
- Clinical suspicion of DVT: edema, tenderness over the calf, Homan's sign
- Clinical suspicion of PE: chest pain, shortness of breath, tachycardia, tachypnea
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 the artery (artery is anterior)
- 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
File:DVT Bowra
Incompressible left Common Femoral Vein[2]
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
- Does not rule out calf DVTs
- For a more thorough exam, scan from the saphenofemoral junction down through the adductor canal in addition to the areas described above
- Use a curvilinear probe for obese or edematous patients
- An appropriate amount of pressure gives complete collapse of the vein as well as some (but not full) compression of the adjacent artery.[3]
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.
Clips
Normal Study - No DVT
Abnormal Study - Incompressible left Common Femoral Vein
![Incompressible left Common Femoral Vein[4]](/wiki/File:DVT_Bowra.gif)
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.
- ↑ http://www.thepocusatlas.com/soft-tissue-vascular/
- ↑ Kline JA et al. Annals of Emerg Med, 2008. PMID: 18562044
- ↑ http://www.thepocusatlas.com/soft-tissue-vascular/