Venous thromboembolism is a common condition found in patients of all walks of life, whether idiopathic, secondary to a clotting disorder, or provoked due to recent surgery, trauma, or supplemental hormone use. Point-of-care ultrasound allows for rapid screening and diagnosis of deep venous thrombosis in patients who may present in the outpatient setting with a painful or swollen leg or those immobilized in the intensive care unit. While there are multiple different causes of a painful and/or swollen leg such as cellulitis, thrombophlebitis, injury, lymphadenopathy, etc., deep venous thrombosis can become life-threatening if the clot propagates toward the heart and enters the pulmonary arteries causing a pulmonary embolism. For this reason, diagnosing and treating deep venous thrombosis is of great importance. This chapter will review basic lower extremity venous anatomy, image acquisition, normal ultrasound anatomy, and interpretation of pathology.
KeywordsDeep venous thrombosis Blood clot Venous thromboembolism Acute thrombus Chronic thrombus
Comparison between vein and artery. On the left is the femoral artery which has a thick muscular wall that is pulsatile on cine loop and maintains its circular structure. On the right is the femoral vein which has a thin wall and increased compliance therefore lacks a specific shape. Veins are easily compressible under pressure (MP4 2027 kb)
Common femoral vein. Common femoral vein, adjacent to the common femoral artery, completely compresses when pressure is applied (MP4 2090 kb)
Common femoral vein with greater saphenous vein. The greater saphenous vein (SAPH) is draining into the common femoral vein (CFV) from the medial side of the vessel. The femoral artery is located lateral, or to the left, of the common femoral vein in this image (MP4 2187 kb)
Bifurcation with superficial and deep femoral veins (in transverse). The common femoral vein bifurcates into the superficial and deep femoral vein. The superficial femoral vein is in the near field, and the deep femoral vein is in the far field (MP4 2147 kb)
Popliteal vein. Popliteal vein is in the near field above the popliteal artery (MP4 2051 kb)
Trifurcation. The popliteal vein trifurcates into the anterior tibial, posterior tibial, and peroneal veins (MP4 2112 kb)
Completely compressed vein. This video demonstrates a vein completely collapsing when the vein is compressed (MP4 2047 kb)
Noncompressible common femoral vein. Using compression, the greater saphenous vein collapses completely, while the common femoral vein does not, indicating deep venous thrombosis (MP4 2089 kb)
Noncompressible deep and superficial femoral veins. Using compression both the deep and superficial femoral veins do not collapse indicating deep venous thrombosis in both vessels (MP4 2154 kb)
Acute thrombus. An acute thrombus appears as a noncompressible vein with hypoechoic material within the lumen of the vein (MP4 2151 kb)
Chronic thrombus. A chronic deep vein thrombus appears a noncompressible vein with hyperechoic material within the lumen of the vein (MP4 2148 kb)
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