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Age: 15

Sex: Male

Indication: Bilateral lower extremity swelling and pain

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Case #50


Findings

  • Intraluminal echogenic material in the right common femoral, femoral, profunda femoral, and greater saphenous veins with incomplete compressibility and thickening of the wall of the common femoral vein
  • Flow is present in these veins on color Doppler analysis
  • Normal appearance of the distal deep veins in the right lower extremity
  • Normal appearance of the deep veins in the left lower extremity


Diagnosis

Chronic deep venous thrombosis

Sample Report

Partially occlusive thrombus in the right common femoral, femoral, profunda femoral, and greater saphenous veins, favored chronic. Preserved flow in these veins.

No evidence of deep venous thrombosis in the left lower extremity.


Discussion

  • Although ultrasound cannot always definitively differentiate acute from chronic deep venous thrombosis (DVT), some findings that favor chronic DVT include:
    • Peripheralization of thrombus within the vessel lumen
    • Irregular, narrowed appearance of affected vessel (often will be expanded in acute DVT)
    • Development of venous collaterals


Images

Echogenic material located peripherally within the vessel lumen (red arrows) with preservation of blood flow centrally, which is a typical appearance for chronic, recanalized DVT.

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