Venous duplex MUT

Patient position: __

reverse trandelenburg

__ - perform with and without compressions

b-mode

__ - show full filling of vessels and directionality

color

__ - waveform morphology

PW doppler

__ - patient in reverse trandelenburg or standing. Add valsalva maneuver or proximal compressions to stress valves

insufficiency testing

Normal veins fully compress = __

coaptation

__ - phasic, spontaneous, and augmentation

normal

Normal = no __ when standing or during valsalva/prox comp

reflux

__ - dark, dilated incompressible

acute DVT

__ US:

• larger vein size

• spongy texture

• poorly attached to the walls

acute DVT US

Acute DVT

__ - no signal or trace amounts along walls

color

Acute DVT

__ - proximal obstruction

continuous doppler

Acute DVT

__ - indicate proximal or distal DVT

no augmentations

__ US

• smaller vessel size

• thicker walls

• hyperechoic striations

• linear bands scattered within vessel

chronic DVT US

Chronic DVT flow __ throughout vessel, patchy color flow

recanalizes

Chronic DVT will have a __ compressible vessel

partially

With chronic DVT you might see __ veins

collateral

Chronic DVT

__ - may be normal.

doppler

Chronic DVT

May have evidence of __

reflux

__ - flow augments DURING valsalva or proximal compression

venous insufficiency

Venous insufficiency flow is __ through valves during the valsalva maneuvers

retrograde

Venous insufficiency

Reflux lasting >__sec = vascular incompetence

0.5

Venous insufficiency

Reflux >0.5sec = __

vascular incompetence

Varicose veins should be __ and __

documented and compressible

Varicose veins will demonstrate __ flow during valsalva or proximal compression

augmented

Varicose veins will demonstrate augmented flow during __ or __

valsalva or proximal compression

__ - if easily visible and >3mm = insufficiency

perforating veins

perforating veins - if easily visible and >__mm = insufficiency

3

Perforating veins normal flow direction is __ to __

superficial to deep

Perforating veins during valsalva turns __ when abnormal

red

__ - usually in groin

lymph nodes

Lymph nodes have a __ rim and __ hilum

hypoechoic, echogenic

An abnormal measurement = >__cm

2

__ - fluid found infiltrating tissues

edema

__ - fluid at joint, anterior to bone

joint effusion

__ - cyst filled with synovial fluid in medial pop fossa

bakers cyst

Abnormal venous duplex

__ - hepatopedal flow (towards the liver) and minimally phasic, almost continuous

portal vein

What three things describe the portal vein flow system?

hepatopedal, minimally phasic, almost continuous

__ - increased pressure in the portal system most likely caused by cirrhosis of liver or other chronic liver disease

portal hypertension

What is portal hypertension most likely caused by?

cirrhosis

Portal hypertension - increased resistance of liver cause flow reversal = __

hepatofugal

When portal hypertension gets hepatofugal flow in the portal vein there are __ that get blood to the liver

portosystemic collaterals

Abdominal __ caused by portal hypertension may be found near spleen, stomach, and esophagus

varices

where do you see abdominal varices seen with portal hypertension?

spleen, stomach, and esophagus

Portal hypertension

Dilated __ vein drains stomach

coronary

Portal hypertension

__ vein may also be present

recanalized paraumbilical vein

__ veins have hepatofugal and triphasic pattern

hepatic

__ - occlusion of hepatic veins and possible IVC

budd-chiari

enlargement of hepatic veins and IVC: caused by __ heart failure

rt sided

__ - invasion of renal cell carcinoma

IVC tumor

If you see a IVC tumor where should you look?

kidneys