US DVT

LOWER EXTREMITY DVT

• Use the 9L linear transducer (5L in groin if big patient)

• Use the LEV preset settings on the GE machine

• PROTOCOL

  • EIV

    • Longitudinal grayscale

    • Longitudinal color flow

    • Longitudinal Doppler (get respiratory phasicity)

  • CFV/GSV (“Mickey mouse” )

    • Transverse with compression

    • "Mickey mouse"

      • Medial ear = saphenous vein/saphenofemoral confluence

      • Face = CFV

      • Lateral ear = SFA

• • BONUS POINTS FOR BIFURCATION

    • Longitudinal bifurcation of CFV into: 

      • Deep FV (profunda) 

      • FV (superficial)  

  • Femoral vein (FV), aka superficial FV

    • Proximal FV: Transverse with compression

    • Mid FV: Transverse with compression

    • Distal FV: Transverse with compression (if can't get compression, get color)

  • Popliteal Vein

    • Transverse with compression

    • Longitudinal grayscale

    • Longitudinal color flow

    • Longitudinal doppler + augmentation

  • Check popliteal fossa for Baker's cysts  

  • BONUS points for calf veins

UPPER EXTREMITY DVT

• Spontaneous DVT is uncommon

• More common from a central chest lesion, so check CXR first!

• CT better for central veins (can’t see beyond clavicle)

• Use L7 probe

• Start at AC fossa to find pair of brachial veins next to artery

• Protocol  

  • IJV

    • Longitudinal color flow

    • Transverse with compression 

  • IJV/subclavian vein confluence

    • Longitudinal color flow

  • Subclavian vein (can't compress)

    • Longitudinal waveform

    • Contralateral subclavian vein longitudinal waveform

  • Axillary vein (place patient's arm over head)

    • Longitudinal color flow

    • Transverse with compression

  • Brachial vein

    • Transverse with compression

  • Cephalic vein

    • Transverse with compression

  • Basilic vein

    • Transverse with compression