chapter 18 : duplex ultrasound imaging of the upper extremity venous system

stasis

thrombi in lower extremity often caused by —; not so in the upper extremity

soleal sinuses

upper extremities do not have —

superficial veins

affected more in arms than in legs; in addition, superficial thrombosis may have greater clinical significance in arm than leg

variable

venous anatomy of upper extremity is more — than lower extremity

superior vena cava thrombosis

facial swelling or dilated chest wall collaterals are suggestive of —

signs & symptoms of lower extremity

• unilateral arm or hand swelling

• superficial palpable cord

• erythema

• pain and tenderness

• facial swelling or dilated chest wall collaterals

pulmonary embolism (PE)

upper extremity veins may also be evaluated in patients suspected of —

injury to vessels wall

upper extremity thrombosis is more commonly due to —

subclavian & internal jugular veins

commonly used for indwelling catheters and pacemaker wire introduction

• can be associated with upper extremity thrombosis

peripherally inserted central catheters (PICCS)

is inserted through basilic or cephalic vein and then positioned near right atrium

• can also cause thrombosis

paget-schroetter syndrome

venous thrombosis associated with compression of subclavian vein at the thoracic outlet

• typically patients are young, athletic, and muscular males

effort thrombosis

paget-schroetter syndrome is also known as —

midrange (5-10 MHz) linear array

used to evaluate internal jugular, brachiocephalic, subclavian, axillary, deep brachial, and brachial veins

higher frequency (10-18 MHz) linear array

used for more superficial veins (cephalic and basilic) and small forearm veins (radial and ulnar)

curved or sector array

may be useful for deeper vessels near clavicle and sternum

carotid artery

can be used as a landmark to identify internal jugular vein (IJV)

sitting or standing

IJV will be collapsed if patient is —

external jugular vein (EJV)

serves as an important collateral pathway

• runs without an accompanying artery very close to skin surface

• usually terminates into subclavian vein

Brachiocephalic veins

most often evaluated at the confluence of the IJV and subclavian veins

• compressions cannot be performed

ultrasound image of the brachiocephalic vein

subclavian vein

• can be visualized above or below the clavicle

• accompanied by an artery

cephalic vein terminates into the — just after it passes under clavicle

• taking a quick, deep breathing through pursed lips will cause the vein to collapse

cephalic vein

travels superfically near skin across shoulder and along anterolateral border of biceps muscle

• communicates with median cubical vein at antecubital fossa

• in the forearm, usually travels as two vessels. one on the collar aspect and one on the dorsal aspect

median cubical vein

connects cephalic and basilic veins

• resides in the antecubital fossa but pattern of connection is variable

• common site of venipuncture and therefore thrombus

axillary vein

terminates at the junction of the cephalic and subclavian veins

• accompanied by artery

• courses deeply from shoulder through axilla

basilic vein terminates into — in near the distal axilla

brachial vein

terminates when the basilic vein enters to become axillary vein

• accompanied by an artery

formed by junction of the two radial and two ulnar arteries near the antecubital fossa

radial veins (thumb side)

course along velar aspect of forearm

• very small vessels and rarely involved in venous thrombosis

• paired with an artery

ulnar veins (pinky side)

also travel along velar aspect of forearm

• paired vein that also has an accompanying artery

basilic vein

terminates into the axillary vein in upper arm

• courses medially and superficially without a companion artery

• usually largest vein in upper arm region

• communicates with cephalic vein via median cubital vein in the antecubital fossa

respiration

vein diameter will change slightly with —