Prevalence of upper extremity deep venous thrombosis diagnosed by color Doppler duplex sonography in cancer patients with central venous catheters.

OBJECTIVE: The purpose of this study was to review the literature concerning upper extremity deep venous thrombosis (UEDVT) diagnosed by color Doppler duplex sonography (CDDS) in cancer patients with indwelling central venous catheters (CVCs). METHODS: From computerized databases (MEDLINE and Ovid), relevant publications regarding CDDS of the upper limb veins in cancer patients with CVCs were reviewed. RESULTS: Patients with malignancy have a higher rate of thrombosis, which is increased by the presence of CVCs. Screening CDDS in asymptomatic patients showed CVC-related UEDVT in 11.7% to 44% of patients. In symptomatic cancer patients, the range was similar to the asymptomatic ones, 6.7% to 48%. The presence of a CVC almost doubled the incidence of UEDVT in symptomatic patients. Color Doppler duplex sonography is an accurate examination for the diagnosis of UEDVT, with sensitivity ranging from 78% to 100% and specificity ranging from 82% to 100%. The main obstacle for the diagnosis of UEDVT is the presence of overlying bones, making it difficult to visualize and impossible to directly assess by compression techniques. Color and spectral Doppler sonography and the use of small transducers aid in the diagnosis. When several parameters are evaluated in combination, CDDS is a reliable method for diagnosing CVC-related thrombosis. CONCLUSIONS: Great variability in the prevalence of catheter-related thrombosis in cancer patients has been reported, although it is uniformly higher compared with patients without cancer. Color Doppler duplex sonography is the modality of choice for the diagnosis of CVC-related UEDVT in symptomatic cancer patients and for screening for asymptomatic thrombosis in this specific population.     

Lower-extremity deep venous thrombosis after upper-extremity port catheter placement: an unusual complication

We describe the case of a woman with breast carcinoma who experienced deep venous thrombosis of the right lower extremity after placement of a double-lumen central venous chemotherapy port catheter in the left upper extremity. Color Doppler sonography revealed a linear tubular structure within the right common femoral vein and sonographic features of thrombosis, suggesting deep venous thrombosis secondary to displacement of the port catheter.     

Diagnosis of pregnancy-associated uterine venous plexus thrombosis on the basis of transvaginal sonography.

OBJECTIVE: To describe the sonographic signs of uterine venous plexus thrombosis. METHODS: Four pregnant patients had a diagnosis of uterine venous plexus thrombosis in the first half of gestation. The diagnosis was based on transvaginal sonography only in 3 cases, and the fourth had magnetic resonance imaging corroboration. RESULTS: All 4 patients had similar sonographic features of uterine venous plexus thrombosis on transvaginal sonographic examination. The thrombi within the dilated veins were shown as elongated echogenic structures along the lumen that appeared round on transverse views of the affected veins. They showed swinging movements provoked by gentle transducer pressure. Power and color Doppler sonography enhanced the uterine venous plexus thrombosis diagnosis by showing blood flow around the thrombi. There were no signs of thromboembolic disease. Sonographic findings in deep leg veins and iliac veins were normal in all cases. Complete thrombophilia studies did not reveal any abnormalities. The uterine venous plexus thrombosis could not be detected on transabdominal sonography and was shown better by transvaginal sonography compared with magnetic resonance imaging. During 3 months of anticoagulation therapy, the thrombi gradually disappeared in all cases. CONCLUSIONS: Focusing on the pelvic veins while performing a transvaginal sonographic study during pregnancy may reveal important findings, which may have clinical implications. The therapeutic treatment of uterine venous plexus thrombosis is controversial and still empirical.     

下肢手术后有症状的下肢深静脉血栓形成

目的:探讨下肢手术后有症状的下肢深静脉血栓形成的临床特点、早期诊断方法和预防措施。方法:对5例下肢手术后发生有症状的下肢深静脉血栓形成患者的临床表现和彩色多普勒结果进行分析。结果:下肢手术后小腿出现疼痛是下肢深静脉血栓形成最早出现并具有很高诊断价值的临床特点。手术后肢体加压包扎是促进下肢深静脉血栓形成的可能因素。结论:下肢手术后出现小腿后侧疼痛时应考虑下肢深静脉血栓形成的可能,彩色多普勒检查可明确诊断。对高危患者围手术期应采取综合预防措施。     

Sonographic evaluation of vascular injuries.

OBJECTIVE: The purpose of this presentation is to highlight the color Doppler duplex sonographic features of procedure-related and blunt or penetrating trauma-related vascular injuries. METHODS: Different kinds of vascular complications such as pseudoaneurysms, arteriovenous fistulas, dissection, and thrombosis are discussed. Cases of vascular injuries in the extremities, neck, and abdomen are presented to illustrate the spectrum of sonographic appearances. RESULTS: Color Doppler duplex sonography is valuable in the diagnosis and monitoring of most vessel injuries and in the treatment of pseudoaneurysms. It is useful for flow analysis and for follow-up after treatment. However, because of limitations inherent to sonography, such as bones, air, casts, skin burns, and relatively slow performance of the test, magnetic resonance imaging, computed tomography, and angiography are necessary for further evaluation in selected cases. CONCLUSIONS: Color Doppler duplex sonography is a widely available, noninvasive, and accurate technique for evaluating vascular injuries and should be the first-line imaging modality in most patients.     

It's Not All Deep Vein Thrombosis: Sonography of the Painful Lower Extremity With Multimodality Correlation

The purpose of this pictorial essay is to review different etiologies for lower extremity pain encountered on lower extremity venous sonography including acute deep venous thrombosis, chronic postthrombotic change, central venous disease, common arterial pathologies, and nonvascular abnormalities.     

下肢深静脉血栓形成的彩色多普勒超声诊断

目的：评价彩色多普勒诊断下肢深静脉血栓形成的价值。方法：对45例下肢深静脉血栓形成病例进行常规超声和彩色多普勒血流显像（CDFI）检测,观察血栓形成的部位,大小,栓塞程度,结果：单左侧32例,单右侧10例,双侧3例,安全性阻塞105个部位,不完全性阻塞21个部位。结论：彩色多普勒超声作为一种无创方法对下肢深静脉血栓形成的诊断具有高度敏感性,可作为首选。     

Clinical experience with upper extremity venous sonography in a high-risk cancer population.

OBJECTIVE: To determine the frequency of sonographically evident upper extremity venous thrombosis in symptomatic cancer patients with and without central venous catheters. METHODS: Retrospective review of 573 consecutive upper extremity venous sonographic reports from a 26-month period was performed. Findings including distribution of venous thrombosis, the presence of a central line, cancer type, and miscellaneous findings were recorded. RESULTS: Overall, 514 studies (90%) had satisfactory visualization of all upper extremity vessels; 53 (9%) had limited visualization of 1 or more vessels; and 6 (1%) were inconclusive. Venous thrombosis was present in 227 (40%) of 573 studies. Of the studies with positive findings, there were 186 acute, 13 chronic, 19 fibrin sheath versus nonocclusive, and 9 superficial thromboses. Central venous catheters were present in 325 (57%) of 573 studies. Sonographically evident thrombosis was present in 157 (48%) of 325 studies with central catheters versus 70 (28%) of 248 studies without central venous catheters (P = .001) CONCLUSIONS: Upper extremity venous thrombosis is common (40%) in symptomatic cancer patients and is nearly twice as frequent in cancer patients with indwelling central venous catheters.     

彩色多普勒超声在下肢深静脉栓塞诊断中的应用价值

目的探讨彩色多普勒超声诊断下肢深静脉血栓(DVT)的应用价值。方法彩色多普勒超声对212例临床怀疑DVT的患者进行血管超声检查,观察双下肢深静脉的走行、管径、血管内壁、管腔内透声及血栓回声特征。结果彩色多普勒超声明确诊断201条深静脉血栓形成。彩超表现为患肢深静脉管径增宽,管腔内可见絮状弱回声、实质低回声或不均匀低弱回声,管腔结构不清,探头轻压不能闭合,病变部位无彩色血流信号或可见狭窄细条状的彩色血流信号。结论彩色多普勒超声能及时诊断急性DVT,为临床提供及时、准确、安全、无创的检查手段,对早期诊断、指导治疗、减少并发症具有重要的临床应用价值。     

彩色多普勒超声对脊髓损伤后并发肺动脉栓塞患者下肢静脉血栓的诊断价值

目的探讨彩色多普勒超声检查对脊髓损伤患者下肢深静脉血栓和肺栓塞的诊断价值。方法对60 例肺动脉栓塞患者(肺栓塞组)和同期35 例无肺栓塞的脊髓损伤住院患者(对照组)进行下肢静脉彩色多普勒超声检查。结果肺栓塞组中,36 例脊髓损伤患者,15 例检出下肢静脉血栓;24 例非脊髓损伤患者,9 例检出下肢静脉血栓。脊髓损伤患者与非脊髓损伤患者相比,两组肺栓塞发生率无显著性差异(P>0.05)。对照组有5 例检出下肢静脉血栓。肺栓塞组与对照组相比,下肢静脉血栓发生率有非常显著性差异(P<0.01)。肺栓塞组中,37 例急性肺栓塞患者,11 例检出下肢静脉血栓;23 例慢性肺栓塞患者,10 例检出下肢静脉血栓。两者检出率无显著性差异(P>0.05)。肺栓塞组中,31 例检出股静脉瓣反流和小腿肌肉间静脉扩张,检出率51.7%;对照组8 例检出,检出率22.9%。两组相比有非常显著性差异(P<0.01)。结论脊髓损伤后肺栓塞患者与非脊髓损伤肺栓塞患者的下肢静脉血栓检出率无明显差别,但均明显高于无肺栓塞的脊髓损伤患者。彩色多普勒超声检查下肢静脉对肺栓塞诊断具有临床价值。     

The importance of monophasic Doppler waveforms in the common femoral vein: a retrospective study.

OBJECTIVE: The purpose of this study was to assess the importance of monophasic waveforms encountered in the common femoral vein during deep venous thrombosis evaluation by a retrospective review of lower extremity venous Doppler (VD) sonography and correlative studies, such as computed tomography (CT) and magnetic resonance imaging. METHODS: A retrospective review was conducted of lower extremity VD studies performed from September 1, 2000, through September 1, 2005. All satisfactory VD studies, which were in compliance with the Intersocietal Commission for the Accreditation of Vascular Laboratories standard protocol, were evaluated for the presence of monophasic waveforms and correlated with CT of the abdomen and pelvis. Studies were evaluated for the causes of monophasic waveforms. Patients younger than 18 years were excluded. RESULTS: A total of 2963 VD examinations were reviewed. One hundred twenty-four of 2963 showed monophasic waveforms. Eighty-nine of the 124 had additional CT examinations within 1 week; 19 had CT within 2 months; and 16 had no additional examinations. Forty-seven of 124 cases revealed deep venous thrombosis extending into the iliac veins, of which 23 were identified by VD sonography; 26 were due to extrinsic compression; 6 showed a hypoplastic or stenosed common iliac vein; and the remaining 45 had no apparent causes for the monophasic waveforms. CONCLUSIONS: Monophasic waveforms in the common femoral veins are reliable indicators of proximal venous obstruction. Because iliac vein thrombosis is clinically important, we recommend routine sonographic evaluation of external iliac veins in the presence of monophasic waveforms and CT or magnetic resonance imaging, if necessary, to determine the cause of the monophasic waveforms.     

彩色多普勒超声对上肢深静脉血栓的诊断价值

目的探讨彩色多谱勒超声对上肢深静脉血栓中的诊断价值。方法应用彩色多普勒超声检查32例拟诊为上肢深静脉血栓的患者,观察静脉管腔内回声、血栓形成的范围、血流分布及频谱特征。结果彩色多普勒超声可表现为腔内强弱不等回声和充盈缺损,示无血流信号或血流频谱不随呼吸变化。结论彩色多普勒超声对上肢深静脉血栓的诊断可作为首选方法,其便于对血栓进行动态监测,可为临床治疗及疗效评价提供可靠的依据。     

Lymphoma of the testis and epididymis mimics chronic inflammation upon sonography

We report the sonographic findings in a case of lymphoma, which mimicked chronic inflammation. Scrotal gray-scale sonography revealed an irregularly margined, hypoechoic mass in the right testis and epididymis. Color Doppler sonography showed increased blood flow within the hypoechoic lesions in both testis and epididymis. Pathologic examination revealed a diffuse involvement of the testis and epididymis.     

彩色多普勒超声联合直接法多层螺旋CT静脉造影诊断深静脉血栓的临床研究

目的探讨彩色多普勒超声联合直接法多层螺旋CT静脉造影(MSCTV)诊断深静脉血栓的临床应用价值。方法收集13例经临床证实的深静脉血栓患者的影像学资料,分析其直接法MSCTV及彩色多普勒超声影像特征。结果上肢深静脉血栓2例,下肢深静脉血栓11例。直接法MSCTV深静脉血栓表现为充盈缺损,静脉腔变细、闭塞,侧支血管迂曲、扩张;彩色多普勒超声深静脉血栓表现为静脉腔内的实性回声,周围无血流信号或仅有细小血流信号。结论深静脉血栓具有典型的MSCTV及彩色多普勒超声征象,彩色多普勒超声联合直接法MSCTV能够及时、准确地诊断深静脉血栓。     

Bilateral femoral artery aneurysms and bilateral common femoral vein thromboses

We report the sonographic findings of a patient with bilateral femoral artery aneurysms with concomitant bilateral deep venous thrombosis of the common femoral veins. Femoral arterial aneurysms may be associated with additional arterial aneurysms, and rarely with associated venous thrombosis. Patients presenting with femoral artery aneurysms should undergo a thorough vascular sonographic examination that includes the abdominal aorta, the iliac vessels and the deep venous system of the lower extremity. © 2008 Wiley Periodicals, Inc. J Clin Ultrasound, 2009     

彩色多普勒超声观察下肢深静脉血栓形成病理转归过程中的价值

目的:探讨彩色多普勒超声观察下肢深静脉血栓形成的病理转归过程中的价值及其血流动力学变化规律。方法:应用彩色多普勒超声分别在不同阶段测定79条形成下肢深静脉血栓患肢的静脉各测值间的变化情况,结合相应阶段临床变化情况进行分析。结果:受累静脉狭窄率在治疗1个月后其均值较入院前明显降低(P<0.01),1～6个月各测之变化不明显(P>0.05)。静脉瓣返流程度在治疗1个月后有10%的受累静脉出现度返流,6～12个月受累静脉返流程度明显加重,其中治疗后12个月时度返流占10%,总返流率达76%。结论:下肢深静脉血栓形成后1个月内其主要病理改变是下肢深静脉的回流障碍;其后回流障碍逐渐改善而静脉返流出现且逐渐加重,并成为下肢深静脉血栓形成12个月后的主要病理改变。彩色多普勒超声能较准确地反映其病理发展和转归过程中的动态变化。     

MR assessment of the extremity veins

This article provides an overview of the technique of magnetic resonance venography (MRV) and its relative value in the diagnostic work-up of suspected lower or upper extremity venous thrombosis. MRV is accurate for diagnosis or exclusion of deep vein thrombosis. MRV should be considered complimentary, in many instances, to the less expensive modality of venous sonography. It is the complimentary use of magnetic resonance techniques at the level of the pelvis and the mediastinum that offers the greatest cost benefit as part of an incremental strategy for the work-up of patients presenting with lower or upper extremity swelling.     

Upper extremity deep vein thrombosis: clinical and treatment characteristics

We aimed to evaluate patients with upper extremity deep vein thrombosis (UEDVT) in terms of the risk factors, symptoms, clinical course, diagnostic approaches and treatment outcome. Thirty-six patients with a diagnosis of UEDVT, comprising 19 males (52.7%) and 17 females (47.3%), were included in the study; the mean (+/- SD) age was 54 +/- 12.3 years. The most common risk factor was central venous catheter use. The treatment protocol consisted of low molecular weight heparin for up to 7 days, followed by oral anticoagulants for up to 6 months. All patients were followed up for 1 year. More than 90% of the patients responded well to treatment. Nine patients (25%) died due to underlying diseases; no patients died secondary to UEDVT. None of the patients developed pulmonary embolus or recurrent deep venous thrombosis, and post-thrombotic syndrome was not observed. The mortality rate was related to the underlying diseases.     

彩色多普勒超声诊断下肢深静脉血栓形成的价值探讨

目的探讨彩色多普勒超声对下肢深静脉血栓（DVT）的诊断价值。方法对131例下肢DVT患者的声像图表现特点进行回顾性分析。结果急性下肢DVT表现为管径增宽，内充满较均匀的低回声，加压后血管不能被压闭，CDFI示无彩色血流信号或彩色血流信号充盈缺损：亚急性下肢DVT表现为增宽的管腔回缩。腔内实质性回声相对增强，附着于管壁，管壁规整，CDFI示血栓周边可见细点状或细线状血流信号；慢性下肢DVT血栓发生部位管腔狭窄，血栓呈条索状较高回声，紧密附着于管壁使管壁呈不规则增厚，CDFI可探及不同程度的血流信号。结论彩色多普勒超声是检查下肢DVT的最佳方法。     

彩色多普勒超声诊断下肢深静脉血栓的价值

目的探讨彩色多普勒超声检查对下肢深静脉血栓的诊断价值。方法回顾性分析35例下肢深静脉血栓患者的超声声像图特征。其中25例经静脉造影证实,其余10例经手术证实。结果本组35例下肢深静脉血栓患者中急性栓塞7例,亚急性栓塞21例,慢性栓塞7例。急性栓塞超声声像图均表现为管腔内见较均匀实性低回声或极低回声,栓塞部位静脉管腔内径增宽,探头加压管腔不能闭合。CDFI检查栓塞部位无血流信号或探及少量血流信号;亚急性栓塞超声声像图均表现为管腔内为实性中等回声,血栓收缩溶解变小,管腔随之变小,探头加压管腔不能被完全压瘪,CDFI检查管腔边缘处可见较细的条状血流信号;慢性栓塞超声声像图均表现为栓塞部位静脉管径正常或变小,管壁呈部分或弥漫性增厚,回声增强,静脉瓣增厚、僵硬,管腔内呈条索状实性回声,或附壁实性回声,CDFI管腔边缘处可见点线状、轨道状血流,部分可见远段静脉侧支循环开放。结论彩色多普勒超声检查对下肢静脉血栓形成部位及栓塞程度的判断有独特的优越性,具有无创、实时、准确及可重复性强等优点,是下肢深静脉血栓的首选检查方法,可早期发现、及时诊断急慢性下肢静脉血栓。