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Premium member Presentation Transcript Upper Limb Venous Duplex Examination : Upper Limb Venous Duplex Examination Technique and interpretation Etiology of UL venous thrombois : Etiology of UL venous thrombois Catheter 70% Caner 15% Physical strain Hypercoaculable state Drug abuse Obesity Steriods pregnancy Too Many Veins in the UE : Too Many Veins in the UE Venous Evaluation : Venous Evaluation Lower extremity -Compression most helpful -Duplex and imaging secondary role Upper extremity -imagind=colour=spectral are more important Slide 5: Upper limb collateral can be as big as the veins we are studying and causing a common wrong diagnosis of patent subclavian and innominate veins UE Technique : UE Technique Supine , symmetrical posture 5 MHz small foot print transducer preferable Supraclavicular for central veins Infraclavicular for peripheral veins Jugular,innominate,subclavian and axillay veins first Arm veins as needed Some patients limited study of arms Compression in UE : Compression in UE Difficult and not always possible Use Sniff test Technical considerations : Technical considerations Use small footprint transducers that allows easier central evaluation Color Doppler is easier than in LE Use color , sniff where compression is impossible Bilateral study is usueal , Asymmetrical spectral waveform a common clue to disease Compression Ultrasound : Compression Ultrasound Left innominate breath holding : Left innominate breath holding Sniff early and late : Sniff early and late UE Venous Protocol : UE Venous Protocol Imaging color and spectral doppler of Jugular , innominate , central subclavina and mid subclavian and peripheral subclavian and axillay vein and SVC if possible Long and short axis if possible Compression to jugular , axillary , arm veins and peripheral part of subclavian vein . Normal Jugular vein : Normal Jugular vein Normal UE Doppler Findings : Normal UE Doppler Findings Cental veins : Pulsatile and phasic variation Peripheral veins Phasic variation Pulsatible variation +/- Bilateral symmetry Color filling in all veins Normal Right Innominate Vein : Normal Right Innominate Vein Normal Right Innominate : Normal Right Innominate With prominent cardiac pulsations Right Subclavian Veins central : Right Subclavian Veins central Normal Right Mid Subclavian vein : Normal Right Mid Subclavian vein Normal Right P Subclavian vein : Normal Right P Subclavian vein Normal Axillary Vein : Normal Axillary Vein Normally have a flow reversal of blood Normal Left Innominate : Normal Left Innominate Innominate and SVC : Innominate and SVC Abnormal UE Doppler Findings : Abnormal UE Doppler Findings Loss of Pulsatile variation centrally Continous signal Absent signal Reversal flow Stenotic jet Asymmetry between sides Obstructive Waveform : Obstructive Waveform Asymmetry Axillary : Asymmetry Axillary Echogenic area inside the vein : Echogenic area inside the vein Normal Innominate Vein Reversed Jugular vein : Reversed Jugular vein The jugular vein is the commenest in seeing reverse flow Reverse flow occur in response to central obstruction Subclavian stenosis : Subclavian stenosis Spectral Doppler Interpretation : Spectral Doppler Interpretation Abnormal Doppler indicated A- Ostruction ( unknown aetiology , may be acute or chronid or extrinisic compression) B-Site of abnormality inicated level of obstruction Venous Thrombus ;Imaging : Venous Thrombus ;Imaging Clot visualization Varies by its echogenicity Noise may oscure or minic clot Sniffing may simulate compression Noncompressibility as appropriate Catheters and Pitfallas : Catheters and Pitfallas Thrombus Aging : Thrombus Aging Acure Thrombus Expand vein Free floating Smooth Deformable if compressed Jugular vein thrombus recent : Jugular vein thrombus recent Axillary vein thrombosis chronic : Axillary vein thrombosis chronic Pericatheter DVT noncompressible : Pericatheter DVT noncompressible Pericatheter Fibrin Sleeve : Pericatheter Fibrin Sleeve Missed/Found DVT left : Missed/Found DVT left DVT Hared to see gray scale : DVT Hared to see gray scale Scarring (Chronic Changes) : Scarring (Chronic Changes) Normal or small Firm Irregular Retracted Circumferential narrowing Synechia Stenosis can cause arm swelling Scarring : Scarring UE Pitfalls : UE Pitfalls Not all veins are compressible Entire vein may not be imaged Reverberation , noise may mimic clot Nonobstructive thromus may not alter Doppler Collateral may mimic normal vein What is this : What is this Venogram : Venogram You do not have the permission to view this presentation. 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