24-16: Deep Venous Thrombosis Ultrasound

Jeremy S. Boyd; Myles Melton; Jordan D. Rupp; Robinson M. Ferre

Clinical Summary

The presence of a deep venous thrombosis (DVT) is part of the differential diagnosis of a variety of signs and symptoms. Although clinical scoring algorithms have been developed to gauge risk, no clinical findings are conclusive of this condition, and imaging is necessary to confirm the diagnosis. Ultrasound is a sensitive, noninvasive imaging modality that can be performed rapidly and essentially without contraindication. Radiology-performed studies are not always readily available emergently; thus, an emergency physician properly trained in bedside ultrasonography can help guide and hasten care by performing a limited serial compression examination of the proximal leg veins. This exam has been shown to be highly sensitive for diagnosis of DVT in symptomatic ED patients when performed by properly trained individuals.

Indications

Extremity swelling, pain, or erythema
Dyspnea
Chest pain

Required Views for Lower Extremity DVT Ultrasound

Common femoral vein (CFV) (Fig. 24.66)
Superficial femoral vein (SFV) (Fig. 24.67)
Popliteal vein (PV) (Fig. 24.68)

FIGURE 24.66

DVT Ultrasound, CFV View. The transducer should be oriented in a transverse plane just distal to the inguinal ligament. The vein is gently but firmly compressed until the walls completely collapse. (Illustration contributor: Robinson M. Ferre, MD; photo contributor: Lawrence B. Stack, MD; ultrasound contributor: Robinson M. Ferre, MD.)

A photo lies in a supine position with the right leg bent at the knee, and a towel supporting the lower leg. A practitioner places a transducer over the right groin at the top of the thigh, to get a D V T ultrasound in C F V view. Two D V T Ultrasound images show the Common femoral vein (C F V) with no compression, and with compression of the vein. Two illustrations, side by side depicting D V T Ultrasound images, show the Common femoral vein view (C F V) with no compression, and with compression of the vein.

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FIGURE 24.67

DVT Ultrasound, SFV View. The transducer should be oriented in a transverse plane. The vein(s) is/are gently but firmly compressed until the walls completely collapse. (Illustration contributor: Robinson M. Ferre, MD; photo contributor: Lawrence B. Stack, MD; ultrasound contributor: Robinson, M. Ferre, MD.)

A patient lies in a supine position with the right leg bent at the knee and a towel supporting the lower leg. A practitioner places a transducer on the inside of the right upper thigh to get a D V T Ultrasound, in S F V View. Two D V T Ultrasound images show the Superficial femoral vein view, S F V, with no compression, and with compression of the vein. Two illustrations depicting D V T Ultrasound images, show the Superficial femoral vein view (S F V), with no compression, and with compression of the vein.

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FIGURE 24.68

DVT Ultrasound, Popliteal View. The transducer should be oriented in a transverse plane behind the popliteal fossa. The vein is gently but firmly compressed until the walls completely collapse. The popliteal vein is usually found superficial to the popliteal artery, ie, “pop on top.” (Illustration contributor: Robinson M. Ferre, MD; photo contributor: Lawrence B. Stack, MD; ultrasound contributor: Suzanne Bryce, MD.)