Thread by @IM_Crit_

How do you examine the lower extremity venous system when you look for deep vein thrombosis? What points do you check with the probe? Do you use Doppler? What are the recommended protocols? The Society of Radiologists in Ultrasound recommends a complete duplex ultrasound:

👆 The black rectangles represent the extent of the compression US. The gray rectangles are the sites of Doppler.
2-CUS (2-points compression US) includes compression of the femoral veins 1-2 cm above & below the saphenofemoral junction & the popliteal veins
up to the calf veins

ECUS (extended compression US), includes compression US from the common femoral vein through the popliteal vein up to the calf veins confluence

CCUS (complete compression US), includes compression US from the common femoral vein to the ankle

CDUS (complete duplex US), includes compression US from the common femoral vein to the ankle (evaluating
the posterior tibial & peroneal veins in the calf), color
& spectral Doppler of both common femoral (or iliac veins), color & spectral Doppler of the popliteal vein on

the symptomatic side. US of symptomatic areas may be required if the symptoms are not explained by the standard thigh-to-ankle examination

Bonus points:
1. Compression should be performed at 2-cm intervals
2. The 2-points' US is a misleading term; we should refer to 2 regions

3. ECUS can detect isolated femoral vein thrombosis in 5-7% of those with DVT
4. A negative ECUS or 2-region test requires a follow-up
CDUS in 5 days to 1 week
5. Isolated iliac vein DVT occurs in 1.6% of those with DVT. Imaging of the iliac/pelvic veins is warranted in pts whose

signs & symptoms suggest iliocaval disease (eg, whole-leg swelling w normal compression US). This may be accomplished by pelvic venous US, CT, or MRI
6. Chronic postthrombotic change (not chronic thrombus) is the preferred term for the material that persists on US after acute DVT

Thanks for reading!
Pearls were taken from a consensus report published in Circulation 2018; 137: 1505-15. DOI: 10.1161/CIRCULATIONAHA.117.030687

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