<br />
Ultrasound<br />
Focused ultrasound exam<br />
for the detection of DVT<br />
Philips tutorial<br />
Michael Blaivas, MD, FACEP<br />
Professor of Emergency Medicine<br />
Northside Hospital Forsyth, Atlanta, Georgia<br />
Contents<br />
Focused ultrasound exam for the detection of DVT<br />
1 Introduction 3<br />
2 Indications 5<br />
3 Clinical anatomy 7<br />
4 Ultrasound anatomy and techniques 11<br />
5 Clinical pearls and tips 34<br />
6 DVT images and video cases 38<br />
7 References 55<br />
Additional resources 56<br />
2 Contents<br />
1 Introduction<br />
Deep venous thrombosis (DVT) is a significant problem in our<br />
modern society and carries a high morbidity and mortality burden.<br /> <a title="Focused ultrasound exam for the detection of DVT page 1" href="http://viewer.zmags.com/publication/1bb7ca68?page=1"> Ultrasound Focused ultrasound exam for the detec</a>
<a title="Focused ultrasound exam for the detection of DVT page 2" href="http://viewer.zmags.com/publication/1bb7ca68?page=2"> Contents Focused ultrasound exam for the detecti</a>
<a title="Focused ultrasound exam for the detection of DVT page 3" href="http://viewer.zmags.com/publication/1bb7ca68?page=3"> 1 Introduction Deep venous thrombosis (DV</a>
<a title="Focused ultrasound exam for the detection of DVT page 4" href="http://viewer.zmags.com/publication/1bb7ca68?page=4"> The DVT exam protocol performed by radiology and </a>
<a title="Focused ultrasound exam for the detection of DVT page 5" href="http://viewer.zmags.com/publication/1bb7ca68?page=5"> 2 Indications Any patient suspected of havi</a>
<a title="Focused ultrasound exam for the detection of DVT page 6" href="http://viewer.zmags.com/publication/1bb7ca68?page=6"> A typical strategy for the detection of proximal </a>
<a title="Focused ultrasound exam for the detection of DVT page 7" href="http://viewer.zmags.com/publication/1bb7ca68?page=7"> 3 Clinical anatomy Although venous flow i</a>
<a title="Focused ultrasound exam for the detection of DVT page 8" href="http://viewer.zmags.com/publication/1bb7ca68?page=8"> Inguinal ligament Femoral artery Femoral vein Fe</a>
<a title="Focused ultrasound exam for the detection of DVT page 9" href="http://viewer.zmags.com/publication/1bb7ca68?page=9"> [Figure 2] Ultrasound image demonstrating bifurca</a>
<a title="Focused ultrasound exam for the detection of DVT page 10" href="http://viewer.zmags.com/publication/1bb7ca68?page=10"> As the SFV progresses distally, it dives through </a>
<a title="Focused ultrasound exam for the detection of DVT page 11" href="http://viewer.zmags.com/publication/1bb7ca68?page=11"> 4 Ultrasound anatomy and technique Transd</a>
<a title="Focused ultrasound exam for the detection of DVT page 12" href="http://viewer.zmags.com/publication/1bb7ca68?page=12"> Patient positioning Ideally the patient is in the</a>
<a title="Focused ultrasound exam for the detection of DVT page 13" href="http://viewer.zmags.com/publication/1bb7ca68?page=13"> Technique The ultrasound exam is performed by com</a>
<a title="Focused ultrasound exam for the detection of DVT page 14" href="http://viewer.zmags.com/publication/1bb7ca68?page=14"> [Figure 5a] Color overlay on the ultrasound image</a>
<a title="Focused ultrasound exam for the detection of DVT page 15" href="http://viewer.zmags.com/publication/1bb7ca68?page=15"> [ Video 1 ] Video demon</a>
<a title="Focused ultrasound exam for the detection of DVT page 16" href="http://viewer.zmags.com/publication/1bb7ca68?page=16"> [ Video 2 ] Video demon</a>
<a title="Focused ultrasound exam for the detection of DVT page 17" href="http://viewer.zmags.com/publication/1bb7ca68?page=17"> If there is any confusion about vessel identity, </a>
<a title="Focused ultrasound exam for the detection of DVT page 18" href="http://viewer.zmags.com/publication/1bb7ca68?page=18"> Pulse wave Doppler is the most sensitive and accu</a>
<a title="Focused ultrasound exam for the detection of DVT page 19" href="http://viewer.zmags.com/publication/1bb7ca68?page=19"> [Figure 7] The Doppler sample volume is placed in</a>
<a title="Focused ultrasound exam for the detection of DVT page 20" href="http://viewer.zmags.com/publication/1bb7ca68?page=20"> If there is difficulty identifying vasculature fr</a>
<a title="Focused ultrasound exam for the detection of DVT page 21" href="http://viewer.zmags.com/publication/1bb7ca68?page=21"> [ Video 3 ] Transverse </a>
<a title="Focused ultrasound exam for the detection of DVT page 22" href="http://viewer.zmags.com/publication/1bb7ca68?page=22"> Continue to compress the CFV through the junction</a>
<a title="Focused ultrasound exam for the detection of DVT page 23" href="http://viewer.zmags.com/publication/1bb7ca68?page=23"> [Figure 9] This ultrasound image demonstrates the</a>
<a title="Focused ultrasound exam for the detection of DVT page 24" href="http://viewer.zmags.com/publication/1bb7ca68?page=24"> [ Video 4 ] Long-axis i</a>
<a title="Focused ultrasound exam for the detection of DVT page 25" href="http://viewer.zmags.com/publication/1bb7ca68?page=25"> Any lack of complete collapse of the venous lumen</a>
<a title="Focused ultrasound exam for the detection of DVT page 26" href="http://viewer.zmags.com/publication/1bb7ca68?page=26"> Comparing transverse and long-axis images may hig</a>
<a title="Focused ultrasound exam for the detection of DVT page 27" href="http://viewer.zmags.com/publication/1bb7ca68?page=27"> [Figure 11] In the popliteal fossa the transduce</a>
<a title="Focused ultrasound exam for the detection of DVT page 28" href="http://viewer.zmags.com/publication/1bb7ca68?page=28"> [Figure 12] Ultrasound image of the popliteal art</a>
<a title="Focused ultrasound exam for the detection of DVT page 29" href="http://viewer.zmags.com/publication/1bb7ca68?page=29"> [ Video 5 ] The video d</a>
<a title="Focused ultrasound exam for the detection of DVT page 30" href="http://viewer.zmags.com/publication/1bb7ca68?page=30"> [ Video 6 ] Video demon</a>
<a title="Focused ultrasound exam for the detection of DVT page 31" href="http://viewer.zmags.com/publication/1bb7ca68?page=31"> [Figure 13] Ultrasound image demonstrating calf v</a>
<a title="Focused ultrasound exam for the detection of DVT page 32" href="http://viewer.zmags.com/publication/1bb7ca68?page=32"> [Figure 14] Ultrasound image demonstrating the po</a>
<a title="Focused ultrasound exam for the detection of DVT page 33" href="http://viewer.zmags.com/publication/1bb7ca68?page=33"> It is important to note that nothing precludes th</a>
<a title="Focused ultrasound exam for the detection of DVT page 34" href="http://viewer.zmags.com/publication/1bb7ca68?page=34"> 5 Clinical pearls and tips • Many patients </a>
<a title="Focused ultrasound exam for the detection of DVT page 35" href="http://viewer.zmags.com/publication/1bb7ca68?page=35"> DVT appearance – DVTs can appear differently depe</a>
<a title="Focused ultrasound exam for the detection of DVT page 36" href="http://viewer.zmags.com/publication/1bb7ca68?page=36"> Difficult to visualize vasculature – Morbidly obe</a>
<a title="Focused ultrasound exam for the detection of DVT page 37" href="http://viewer.zmags.com/publication/1bb7ca68?page=37"> Common mimics of DVT pain – There are several com</a>
<a title="Focused ultrasound exam for the detection of DVT page 38" href="http://viewer.zmags.com/publication/1bb7ca68?page=38"> 6 DVT images and video cases </a>
<a title="Focused ultrasound exam for the detection of DVT page 39" href="http://viewer.zmags.com/publication/1bb7ca68?page=39"> [Figure 16] Example of a large thrombus. There is</a>
<a title="Focused ultrasound exam for the detection of DVT page 40" href="http://viewer.zmags.com/publication/1bb7ca68?page=40"> [Figure 17] Example of a large thrombus with area</a>
<a title="Focused ultrasound exam for the detection of DVT page 41" href="http://viewer.zmags.com/publication/1bb7ca68?page=41"> [Figure 18] Long-axis image of a popliteal vein t</a>
<a title="Focused ultrasound exam for the detection of DVT page 42" href="http://viewer.zmags.com/publication/1bb7ca68?page=42"> [Figure 19] Image on the left is a normal image a</a>
<a title="Focused ultrasound exam for the detection of DVT page 43" href="http://viewer.zmags.com/publication/1bb7ca68?page=43"> [Figure 20] Long-axis image demonstrating a dista</a>
<a title="Focused ultrasound exam for the detection of DVT page 44" href="http://viewer.zmags.com/publication/1bb7ca68?page=44"> [Figure 21] Ultrasound image demonstrating a thro</a>
<a title="Focused ultrasound exam for the detection of DVT page 45" href="http://viewer.zmags.com/publication/1bb7ca68?page=45"> [ Video case 1 ] Video </a>
<a title="Focused ultrasound exam for the detection of DVT page 46" href="http://viewer.zmags.com/publication/1bb7ca68?page=46"> [ Video case 2 ] Left c</a>
<a title="Focused ultrasound exam for the detection of DVT page 47" href="http://viewer.zmags.com/publication/1bb7ca68?page=47"> [ Video case 3 ] Video </a>
<a title="Focused ultrasound exam for the detection of DVT page 48" href="http://viewer.zmags.com/publication/1bb7ca68?page=48"> [ Video case 4 ] Transv</a>
<a title="Focused ultrasound exam for the detection of DVT page 49" href="http://viewer.zmags.com/publication/1bb7ca68?page=49"> [ Video case 5 ] Longit</a>
<a title="Focused ultrasound exam for the detection of DVT page 50" href="http://viewer.zmags.com/publication/1bb7ca68?page=50"> [ Video case 6 ] Longit</a>
<a title="Focused ultrasound exam for the detection of DVT page 51" href="http://viewer.zmags.com/publication/1bb7ca68?page=51"> [ Video case 7 ] Video </a>
<a title="Focused ultrasound exam for the detection of DVT page 52" href="http://viewer.zmags.com/publication/1bb7ca68?page=52"> [ Video case 8 ] Long-a</a>
<a title="Focused ultrasound exam for the detection of DVT page 53" href="http://viewer.zmags.com/publication/1bb7ca68?page=53"> [ Video case 9 ] Longit</a>
<a title="Focused ultrasound exam for the detection of DVT page 54" href="http://viewer.zmags.com/publication/1bb7ca68?page=54"> [ Video case 10 ] Color</a>
<a title="Focused ultrasound exam for the detection of DVT page 55" href="http://viewer.zmags.com/publication/1bb7ca68?page=55"> 7 References 1. Enneking FK, Chan V,</a>
<a title="Focused ultrasound exam for the detection of DVT page 56" href="http://viewer.zmags.com/publication/1bb7ca68?page=56"> Additional resources For additional resources</a>
<a title="Focused ultrasound exam for the detection of DVT page 57" href="http://viewer.zmags.com/publication/1bb7ca68?page=57"> This paper reflects the opinion of the author, no</a>