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Ultrasound signs of diseases of the veins of the lower limb
Last reviewed: 19.10.2021
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Ultrasonic dopplerography in the diagnosis of diseases of the veins of the lower limb
Pathological changes
The abnormal results of the compression test confirm the presence of thrombosis. Incomplete thrombosis is partially compressed. The length of the thrombus is determined by finding its proximal end and documenting the longitudinal and transverse images. The exact anatomical location of the proximal end is necessary for control studies. The proximal end of the fresh thrombus is usually not attached to the vascular wall, although the term "free floating thrombus" should not be used because it is ambiguous and its clinical significance is not clear. The best way to estimate thrombus age is to determine the diameter of the thrombosed vein in relation to the same artery. The transverse diameter of the fresh thrombus (<10 days) in the lower limb is more than two diameters of the accompanying artery. Old thrombi have a smaller diameter due to retraction of the clot. The measurement results are documented in the images. Ehogennost thrombus is not a reliable indicator of his age
The standard protocol for patients with suspected deep vein thrombosis is the examination of the veins of not only the lower extremity, but also the pelvis. Sometimes this allows us to reveal the cause of deep vein thrombosis, for example, in the presence of a pathological formation of the pelvis, leading to occlusion of the blood flow. Even small formations, such as a blood clot in the musculoskeletal system, cause severe pain. Patients with rheumatoid arthritis often have Baker cysts.
Diagnostic problems and solutions
The femoral vein in the leading canal is poorly visible
Maintain the hip with your left hand during the examination or try a rear access for the distal sections of the leading channel
Edema of the lower limb
First try alternative diagnostic methods. If this is not possible, identify the femoral vein in the inguinal region and withdraw the popliteal vein. Both can be evaluated using ultrasound. The results, although minimal, can be used to select a method of treatment, especially in the detection of thrombosis.
There is thrombosis, but it is difficult to assess the pelvic vessels
The superficial iliac vein can always be evaluated in the distal part, but the proximal end of the thrombus may not be visible. Usually compression of the inferior vena cava does not present any difficulties. This is important when planning conservative therapy, when ultrasound is diagnosed as a lesion at the level of the pelvis, since it is possible to exclude thrombosis of the inferior vena cava.
Pronounced atherosclerosis in the accompanying arteries creates acoustic shadows, hiding veins
Try to change the position of the sensor and scan behind the artery, going directly to the vein.
Veins of the shin can not be accurately identified
In patients with thick shins, select the position of the sensor, minimizing the distance from the surface to the veins of interest. If they still can not be accurately visualized, try bending the leg and lowering it across the edge of the table.