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Vascular sonography

Test 3 Lower Extremity venous Pathology- DVT

QuestionAnswer
Echogenic material is visualized where? Within the vein lumen
What type of material prevents complete compression of vein walls? Echogenic material
In cases where intraluminal echoes are difficult to visualize, what can used to determine the presence of a thrombus? Increased transducer compression to deform artery can help determine the presence of a thrombus
Duplex imaging cannot only detect presence of a thrombus but also what? The age of a thrombus, which determines the treatment options
What are the characteristic of acute thrombus? Lightly echogenic or hypoechoic thrombus, Poorly attached to vessel wall, Often in center of lumen, Spongy texture of thrombus, Dilated vein, "Rouleaux" flow
What is Rouleaux flow? Slow flow, moves with respirations
What does Rouleaux flow suggest? Proximal obstruction
Acute thrombosis is what? The newly formed thrombus is the fluid and solid contents captured in the thrombin net
What type of thrombus can be invisible on ultrasound? Acute thrombosis
What type of thrombus is poorly attached making it more likely to embolize and cause PE? Acute thrombosis
What type of thrombus is emergent in the deep system? Acute thrombosis
Thrombus should be considered _______ until proven otherwise? Acute
When does an acute thrombus typically turn subacute? typically at 4-12 weeks
What may determine acute vs. subacute thrombus? D-dimer
What does a positive D-dimer indicate? Indicates significant thrombus formation
What does a negative D-dimer indicate? Indicates acute process is not occurring
What are the characteristics of Chronic Thrombus? Brightly echogenic, Well-attached to vessel wall, Rigid texture of thrombus, Contracted vein (only if obstructed), Vessel retracts with aging thrombus, Large collateral, Several months old
What is capable of dissolving Venous Thrombosis? The Thrombolytic system
How long does it take for a thrombus to become chronic? Several months
Chronically thrombosed veins may be difficult to differentiate from what? Surrounding tissue
Does chronic thrombus always obstruct the vein? NO, not always
A chronic thromus may appear as a what within the vein? A thin scar
What are phleboliths? Calcifications
Absence of color flow and spectral waveform will be seen in what? Completely thrombosed veins
If there is no augmentation with distal compression what does that mean? Mean that the obstruction is located between the transducer and the site of distal compression
What does continuous flow (non-phasic with respiration) indicate? Indicates more proximal obstruction and that the pressure in vein exceeds pressure changes within the abdomen during respiration
What are 3 types of abnormal flow? Non-spontaneous flow, pulsatile flow, and Alternating antegrade & retrograde flow
If there is non-spontaneous flow where would the possible obstruction be? Possible obstruction DISTAL to interrogation site
What is associated with pulsatile flow? Arteriovenous fistulae, Systemic venous HTN, Right heart failure (CHF), Pulmonary HTN (fluid overload)
What is extrinsic pressure? Pressure from surrounding structures can alter flow patterns. Ex- Pregnancy, or a tumor
What is alternating antegrade and retrograde flow usually a result of? Valve damage- it is abnormal
What can retrograde flow occur with? Can occur with normal respiration and/or upon provocative maneuvers (valsalva, augmentation)
Increased reversal flow with proximal compression (valsalva) indicates what? "Venous Reflux"
What is May-Thurner Syndrome? Left Common iliac Vein compression (& potentially thrombosis) by the Right Common iliac Artery. Right Common iliac Artery compresses Left Common iliac Vein
What is Phlegmasia Alba Dolens? Extensive iliofemoral DVT that causes marked swelling of lower extremity with pain, pitting edema and blanching
What is Phlegmasia Alba Dolens also known as? Milk leg or White leg
What is Phlegmasis Cerulea Dolens? An extension of Phlegmasia Alba Dolens, causes even more massive sweeling, more severe pain, and cyanosis of limb
What happened to venous outlfow with Phlegmasia Cerulea Dolens? Venous outflow is completely obstructed, May result in arterial insufficiency and venous gangrene
What are some Non-vascular incidental findings? Cysts & Hematomas, Edema, Abscesses, Enlarged lymph nodes, Tumors
What are some Vascular incidental findings? Aneurysms, Pseudo-aneurysms, Arteriovenous fistulas, and significant arterial disease
Always confirm the presence of a thrombus with that? Grey scale imaging
Is it necessary to use angle correct in Venous Doppler? NO
What angle correction will increase sensitivity to flow? 60-70 degress (must use on the JCC comp)
Popliteal Cyst can mimic what? Popliteal DVT, it will not be continous with the popliteal vein or lie along the popliteal atery course when turned to SAG.
What does unilateral continuous flow indicate? Proximal obstruction, or Extrinsic Compression from mass
Bilateral continuous flow indicates what? Shallow breathing, Supine PT, or IVC obstruction-usually bilateral swelling
If Venous and Arterial studies are both ordered what do you do? ALWAYS do Venous first
What are the characteristics of Arterial symptoms? Progressive symptoms, Intermittent pain, Foot/Limb Coolness, Rest pain in feet, and Very painful ulcers (gangrene, narcosis)
What are the characteristics of Venous symptoms? Acute onset, Persistent pain in calf/thigh, Redness of limb, Limb swelling/warmth, Local tenderness, "Homan's sign", Palpable Subcutaneous Card, Stasis Dermatitis, Shallow/irregular ulcers. SOB, CP
What are 3 other imaging procedures? Conventional Contrast Venography (uncommon), Computed Tomography Venography (used to define status of iliac veins) Magnetic Resonance Venography (used to detect DVT, Most useful when above the inguinal ligament)
What is the primary treatment option for DVT? Primary health treatment is Anticoagulation
What are other treatment measures for DVT? Gradient elastic stockings, and Thrombolytic agents and thrombectomies
Created by: EmilyGriffin