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Ultrasound signs of lower extremity vein disease
Last reviewed: 06.07.2025
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Ultrasound Dopplerography in the Diagnosis of Lower Limb Vein Diseases
Pathological changes
Abnormal results of the compression test confirm the presence of thrombosis. Incomplete thrombosispartially compressible. The extent of the thrombus is determined by locating its proximal end and documenting it on longitudinal and transverse images. Accurate anatomical location of the proximal end is necessary for follow-up studies. The proximal end of a fresh thrombus is usually not attached to the vessel wall, although the term "free floating thrombus" should not be used because it is ambiguous and its clinical significance is unclear. The best way to estimate the age of a thrombus is to measure the diameter of the thrombosed vein in relation to the artery of the same name. The transverse diameter of a fresh thrombus (< 10 days) in the lower limb is more than twice the diameter of the accompanying artery. Old thrombi have a smaller diameter due to clot retraction. The results of these measurements are documented on images. Thrombus echogenicity is not a reliable indicator of its age
The standard protocol for patients with suspected deep vein thrombosis is to examine the veins of not only the lower extremity but also the pelvis. Sometimes this can reveal the cause of deep vein thrombosis, for example, if there is a pathological formation in the pelvis that leads to occlusion of blood flow. Even small formations, such as a thrombus in a muscular vein, can cause sharp pain. Baker's cysts are common in patients with rheumatoid arthritis.
Diagnostic problems and solutions
The femoral vein is poorly visible in the adductor canal
Support the thigh with your left hand during the examination or try a posterior approach to the distal adductor canal
Swelling of the lower limb
Try alternative diagnostic methods first. If this is not possible, identify the femoral vein in the groin and bring out the popliteal vein. Both can be assessed by ultrasound. The results, although minimal, can be used to guide treatment, especially if thrombosis is detected.
There is thrombosis, but it is difficult to assess the pelvic vessels
The superficial iliac vein can always be assessed distally, but the proximal end of the thrombus may not be visible. Usually, compression of the inferior vena cava is not a problem. This is important when planning conservative therapy when ultrasound reveals a lesion at the pelvic level, since thrombosis of the inferior vena cava can be excluded.
Severe atherosclerosis in the accompanying arteries creates acoustic shadows that obscure the veins
Try changing the position of the sensor and scan behind the artery, going straight to the vein.
The veins of the leg cannot be identified accurately
In patients with thick calves, select a transducer position that minimizes the surface distance to the veins of interest. If they still cannot be accurately visualized, try bending the leg and lowering it over the edge of the table.