• Registration
  • Login
JETem
  • Home
  • About
    • Aim and Scope
    • Our Team
    • Editorial Board
    • FAQ
  • Issues
    • Current Issue
    • Ahead of Print
    • Past Issues
  • Visual EM
    • Latest Visual EM
    • Search Visual EM
    • Thumbnail Library
  • For Authors
    • Instructions for Authors
    • Submit to JETem
    • Photo Consent
    • Policies
      • Peer Review Policy
      • Copyright Policy
      • Editorial Policy, Ethics and Responsibilities
      • Conflicts of Interest & Informed Consent
      • Open Access Policy
  • For Reviewers
    • Instructions for JETem Reviewers
    • Interested in Being a JETem Reviewer?
  • Topic
    • Abdominal / Gastroenterology
    • Administration
    • Board Review
    • Cardiology / Vascular
    • Clinical Informatics, Telehealth and Technology
    • Dermatology
    • EMS
    • Endocrine
    • ENT
    • Faculty Development
    • Genitourinary
    • Geriatrics
    • Hematology / Oncology
    • Infectious Disease
    • Miscellaneous
    • Neurology
    • Ob / Gyn
    • Ophthalmology
    • Orthopedics
    • Pediatrics
    • Procedures
    • Psychiatry
    • Renal / Electrolytes
    • Respiratory
    • Toxicology
    • Trauma
    • Ultrasound
    • Wellness
    • Wilderness
  • Modality
    • Curricula
    • Innovations
    • Lectures
    • Oral Boards
    • Podcasts
    • Simulation
    • Small Group Learning
    • Team Based Learning
    • Visual EM
  • Contact Us

Use of Bedside Compression Ultrasonography for Diagnosis of Deep Venous Thrombosis

Mohamad Moussa, MD* and Maher Abdo, BS*

*University of Toledo Medical Center, Department of Emergency Medicine, Toledo, OH

Correspondence should be addressed to Mohamad Moussa, MD at Mohamad.Moussa@UToledo.edu 

DOI: https://doi.org/10.21980/J81G94 Issue 2:3
Cardiology/VascularUltrasoundVisual EM
No ratings yet.

History of present illness:

A 70-year-old female with a history of breast cancer and smoking for 50 years presented to the emergency department with left-lower extremity pain and swelling for two days. The patient denied recent long-distance travel, history of hypercoagulable disorder, or recent surgery. Physical examination revealed a warm, erythematous, 3+ edematous left-lower extremity with mild tenderness extending into the proximal thigh. Her D-dimer level was 2307ng/mL and vital signs were significant for a heart rate of 110bpm, oxygen saturation of 90% on 2 liters of oxygen, and blood pressure of 153/102.

Significant findings:

As shown in the still image of the performed ultrasound, a transverse view of the proximal-thigh revealed a visible thrombus (green shading) occluding the lumen of the left common femoral vein (blue ring), which was non-compressible when direct pressure was applied to the probe. Also visible is a patent and compressible branch of the common femoral vein (purple ring) and the femoral artery (red ring), highlighted by its thick vessel wall and pulsatile motion.

Discussion:

Deep venous thrombosis (DVT) affects 1 per 1,000 individuals each year and may lead to complications such as recurrent DVT, pulmonary embolism, and death.1 The utilization of bedside compression ultrasonography allows for rapid diagnosis of DVT and has virtually replaced other diagnostic methods due to its non-invasive and inexpensive nature.

When performing compression ultrasonography, the patient should be positioned to maximize distention of the leg veins. The extremity in question should be flexed at the knee and externally rotated at the hip (this fully exposes of the common, superficial, and deep femoral veins as well as the popliteal fossa) and the head of the bed elevated at a 30-45 degree angle.2

In patients with an elevated D-dimer and low-to-moderate clinical probability, negative compression imaging of a single proximal location of the femoral vein rules out DVT.3 However, those with high clinical probability and negative imaging require additional studies such as complete extremity ultrasound imaging or serial ultrasound surveillance.3 In this case, computed tomography angiography (CTA) was negative for pulmonary embolism (PE); however, bedside ultrasound of the left-lower extremity demonstrated deep venous thrombosis (DVT). The patient was started on enoxaparin and admitted due to the large size of the thrombus and history of poor outpatient follow-up.

Topics:

Ultrasound, US, POCUS, DVT, deep venous thrombosis.

References:

  1. Kim DJ, Byyny RL, Rice CA, Faragher JP, Nordenholz KE, Haukoos JS, et al. Test characteristics of emergency physician−performed limited compression ultrasound for lower-extremity deep vein thrombosis. J Emerg Med. 2016;51(6):684-690. doi: 10.1016/j.jemermed.2016.07.013
  2. Del Rios M, Lewiss, RE, Saul T. Focus on: emergency ultrasound for deep vein thrombosis. ACEP clinical & practice management. https://www.acep.org/Clinical—Practice-Management/Focus-On–Emergency-Ultrasound-For-Deep-Vein-Thrombosis/. Published March 2009. Accessed July 12, 2017.
  3. Bates SM, Jaeschke R, Stevens SM, Goodacre S, Wells PS, Stevenson MD, et al. Diagnosis of DVT. Antithrombotic therapy and prevention of thrombosis. Chest. 2012;141(2 Suppl):e351S-e418S. doi: 10.1378/chest.11-2299
Icon

DVT Ultrasound - Case Report

1 file(s) 557 KB
Download
Icon

DVT Ultrasound - Images

1 file(s) 13.6 MB
Download
Issue 2:3Ultrasound

Reviews:

No ratings yet.

Please rate this





Open Pneumothorax

03 Jul, 17

Perforated Gastric Ulcer with Intra-abdominal...

03 Jul, 17
JETem is an online, open access, peer-reviewed journal-repository for EM educators

Most Viewed

  • Telemedicine Consult for Shortness of Breath Due to Sympathetic Crashing Acute Pulmonary Edema
  • Anticholinergic Toxicity in the Emergency Department
  • The Suicidal Patient in the Emergency Department Team-Based Learning Activity
  • Child Maltreatment Education: Utilizing an Escape Room Activity to Engage Learners on a Sensitive Topic
  • Acute Chest Syndrome

Visit Our Collaborators

About

Education

Learners should benefit from active learning. JETem accepts submissions of team-based learning, small group learning, simulation, podcasts, lectures, innovations, curricula, question sets, and visualEM.

Scholarship

We believe educators should advance through the scholarship of their educational work. JETem gives educators the opportunity to publish scholarly academic work so that it may be widely distributed, thereby increasing the significance of their results.

Links

  • Home
  • Aim and Scope
  • Current Issue
  • For Reviewers
  • Instructions for Authors
  • Contact Us

Newsletter

Sign up to receive updates from JETem regarding newly published issues and findings.

Copyright © 2016 JETem. All rights reserved.