Venous Thrombus Non-Vascular Structures Valsalva Response
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How do you tell if its Acute Vs. Chronic venous thrombus?
The length of a patient's symptoms.
Acute- a period of 14 days
Chronic- has experienced symptoms for longer than 14 days.
What is important to remember about Acute thrombus?
It is more serious than Chronic because high risk of PE.
Chronic thrombus is not actually....
thrombus it is fibrous scar tissue (that looks like plaque) and intima wall thickening.
What is another procedure that can be done besides an valsalva maneuver because a patient can't perform a valsalva maneuver?
What does the valsalva maneuver allow us to check?
Allows us to check the patency of the venous system form the point of Doppler examination to the thorax.
What is used to see distal augmentation the best on ultrasound?
best evaluated with Doppler spectrum or audible Doppler signals.
What is the body's response to thrombus?
Releases an enzyme called Plasminogen from the blood that tries to chemically lyses thrombus.
What are two possible outcomes of Plasminogen?
1.) The thrombus is completely lysed over a period of days to weeks.
2.) In most cases, lysis is incomplete so left with chronic thrombus.
Can someone still have a PE if a lower venous ultrasound is negative?
Yes, it could have came from other veins or already moved to lungs.
What is the likelihood of finding thrombus in patients with bilateral leg swelling?
Very low (5% or less).
What are some nonvascular pathology that can be encountered during venous sonography? (8)
- 1.) Lymphedema
- 2.) Hematoma
- 3.) Muscle injury
- 4.) Adenopathy
- 5.) Soft tissue tumors
- 6.) Popliteal Cysts or Baker's Cysts
- 7.) Joint Effusion
- 8.) Cellulitis or an abscess
What is Adenopathy?
common areas? (2)
refers to the pathological enlargement of lymph nodes, whether from inflammatory or neoplastic causes.
common areas are in the armpit and groin.
What is lymphedema?
Neoplastic or postsurgical obstruction of the lymphatic system resulting in an excess of lymph fluid in the tissue.
What are the symptoms of lymphedema,
on sonogram? (2)
visual- lower extremity swelling (foot or lower leg), pitting edema
on sonogram- "ant farm", numerous subcutaneous fluid channels (reticulated pattern un the subcutaneous fat), enlarged lymph nodes
What can an enlarged lymph nodes be caused by? (2)
- 1.) systemic infection
- 2.) maliganancy
What should you do if you see enlarged lymph nodes? (2)
- 1.) measure them
- 2.) report them
What are the signs of cellulitis or an abscess? (4)
- 1.) swelling
- 2.) skin erythema
- 3.) pain
- 4.) tenderness
What causes cellulitis or an abscess?
a bacterial infection
What is a hematoma?
a bruise: an area with large amount of blood/fluid within the tissue.
What are somethings that may cause a hematoma? (3)
- 1.) trauma (violent or iatrogenic)
- 2.) anticoagulation
- 3.) vigorous exercise (usually in athletes)
Muscle injury causes what?
tearing and bleeding and inflammation
What do soft tissue tumors appear like on sonogram?
What should you do to differ between Baker's cysts and popliteal A. aneurysms?
baker's cyst- no color flow
popliteal A. aneurysms- color flow = blood flow
Can we normally diagnose a joint abnormally with sonogram?
What type of joint abnormally are we likely talking about?
What is considered normal spectral flow when doing a valsalva manuevar?
No flow, blood flow in the leg veins will stop.
What is considered abnormal spectral flow when doing a valsalva maneuver? (2)
1.) Reflux - Any amount of flow above the baseline is considered reflux.
2.) Continous blood flow.
What does continuous blood flow mean when doing an valsalva maneuver?
What are we looking for when we do a distal augmentation?
Patency from where you augment to location of transducer.
What three procedures can we do to check for reflux?
- 1.) valsalva
- 2.) distal augmentation
- 3.) color (blue to red)
What does each large mark measure?
What does it mean when there is less than 0.50 secs?
NO significant reflux
What does it mean when there is more than 0.50 secs?
What does it mean according to Bryan protocol when there is less than 1 second of reflux?
What does it mean according to Bryan protocol when there is 1 to 2 seconds of reflux?
What does it mean according to Bryan protocol when there is more or longer than 2 seconds of reflux?
What does the abbreviation "S" stand for?
What does the abbreviation "Ph" stand for?
What does the abbreviation "VAL" stand for?
What does the abbreviation "PC" stand for?
What does the abbreviation "R" stand for?
release of valsalva
What does the abbreviation "DA" stand for?
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