5 Minute Sono DVT - Click to Learn More

Clinical Indication

Non-traumatic leg pain, shortness of breath, erythematous and/or edematous leg

Probe Selection

Linear (Curvilinear or sector Probe if imaging the Iliac vessels or if the leg is obese)

Additional Views and Measurements

  • Obtain longitudinal images of the vessels.

  • Use the curvilinear or sector probe to obtain images of the iliac vessels.

Tips

  • Place the patient in reverse Trendelenburg or have the patient hang their legs off the edge of the bed-this will help engorge the veins making them more visible. 

  • Use Augmentation to assist in evaluating vessel patency- squeeze the leg distally to your probe while using color Doppler to observe the flow within the vessel. 

  • If you see an appropriate augmentation spike, that is further evidence that there is no clot between your probe and where you squeezed. 

  • A fresh clot can look hypoechoic (dark), make sure to compress to prove that there is no DVT.

  • DVTs will become more hyperechoic as they age and may include calcifications. 

  • BEWARE of Lymph Nodes, they can look suspiciously like clot within a vessel and they are not compressible! Move proximal and distal and rotate the probe to see the borders of the lymph nodes compared to the lumen of the vessels. Obtain Longitudinal views to ensure they are vessels and not lymph nodes. 

  • Use the Color Doppler to show the flow in the arteries and veins.

Notes:

  • DUPLEX = color flow + 2D —> high SEN/SPEC, the addition of compression will greatly increase specificity

  • TRPLEX = color + 2D grey + Pulse wave doppler

  • Compression most important. How much is too much Obliterated lumen - aka walls touching —> COAPTATION of vein.

  • Where to look: popliteal 90% clots are here if you can look anywhere else

  • ADD chart

  • valsalva can help distend the vein, help with pregnant patients or if you are having trouble seeing veins.

  • Augmentation: no distal obstruction

  • Color flow: blue is away from probe. Red is towards to probe. helps to decide artery or vein. large clot would have lack of color flow.

  • Proximal iliacs are common source of pelvic DVT in pregnant patients. you might see turbulent flow or dilated vein or loss of respiratory phsicity, more force for compressions. MRI would be ordered if not able to see with ultrasound.

  • NICE criteria Image below