leg dvt pathology

femoral dvt (thigh)

non occlusive dvt in transverse. flow is demonstated using power doppler ultrasound.

ultrasound image- the proximal extent of the dvt appears as a mobile tongue of thrombus. flow is seen surrounding this non occlusive portion.

ultrasound image- dvt comparison. normal right, dvt in left.

ultrasound mobile superficial thrombosis

superficial thrombophlebitis on ultrasound. the non-occlusive mobile thrombus is visible inside the vein. there is increase echogenicity of the subcutaneous fat surrounding the vein consistant with fovcal inflammation (phlebitis).

ultrasound mobile superficial thrombo-phlebitis

superficial thrombophlebitis ultrasound

ultrasound of a competent vein valve

normal competent venous valve as seen on b mode ultrasound. it is important not to mistake this for thrombus.

ultrasound of a competent valve transverse view

the 2 valve leaflets can be seen meeting in this transverse cross-sectional ultrasound view of the vein. this represents a competent valve however doppler assessment would be required to confirm this.

incompetent vein b mode ultrasound

this swirling slow moving blood is typically seen in veins when using high frequency ultrasound. colour doppler is unlikely to demonstrate flow due to the very slow velocity not creating a doppler shift within the range of the probe. the to-fro nature of the flow indicates incompetence.

video clips of mobile thrombus in the lower limb.

ultrasound image- acute on chronic thrombosis:

the echogenic older thrombus is seen, with the very hypoechoic underlying acute thrombus. this acute phase is difficult to see on b-mode alone. compression and colour doppler must be employed to prove/disprove the existence of a dvt.

ultrasound image- the fusiform dilatation of a venous valve containing thrombus.

popliteal vein dvt

popliteal vein dvt in transverse.

right ultrasound image is attempted compression.

ultrasound image- popliteal vein dvt in longitudinal. a gastrocnemius branch is visible.

calf deep veins (posterior tibial veins & peroneal veins)

transverse ultrasound view of the posterior tibial and peroneal veins.

pre & post compression.

transverse mid calf.

hover mouse over to see the scan plane.

ultrasound image- longitudinal calf veins. split screen, color doppler and b-mode.

a sagittal scan plane for the calf veins.

calf vein pathology

thrombosed posterior tibial veins (highlighted in green when you hover your cursor over the image.

using color doppler ultrasound, flow is clearly seen in the peroneal veins (blue) and peroneal artery (red).

calf muscular vein thrombosis

primarily the gastrocnemius and soleal muscular veins.
there is controversay regarding the efficacy of anticoagulation in the management of gastrocnemius and/or soleal vein thrombosis (management of isolated soleal and gastrocnemius vein thrombosis)

abdominal and pelvic dvt (ivc filter)

it is vital to identify the most proximal extent of the dvt. follow up into the pelvis.

an ivc filter may be inserted in cases of extensive dvt.

ultrasoud image- an ivc filter (highlighted in green) centrally in the ivc.

for information on ivc filters

differential diagnoses

superficial thrombophlebitis

ultrasound image- short saphenous thrombophlebitis.

ultrasound image- transverse view of short saphenous thrombophlebitis.

neovascularisation of thrombus

neo-vascularisation of thrombosus via the peri-venous vessels. these vessels are generally too small to see with ultrasound.

transverse ultrasound view showing one of the feeding vessels.

baker's cyst

ultrasound image- the semimembranosis-gastrocnemial bursa (baker’s cyst): by remembering the name, the anatomical position can be determined to ensure incorrect diagnoses are avoided (for example a popliteal fluid collection associated with a hamstring tear).

ultrasound image- a baker’s cyst is subject to: •haemorrhage (from the knee joint) •septations (when chronic) •rupture (causing medial upper calf pain +/- swelling)

calf tear

ultrasound image- a calf muscle abscess with drainage needle in position.

ultrasound image- a medial gastrocnemius tear at the distal musculo-tendinous junction.

abscess

ultrasound image- a calf muscle abscess with drainage needle in position.

calf muscle abscess ultrasound aspiration

the complex contents of the abscess are seen being drawn into the needle tip.