Chapter 27: Duplex/color flow imaging Venous

Question 1

Duplex of the venous system is used to

Answer 1

identify thrombosis
detect calf lesions
extrinsic compression vs intrinsic obstruction
eval soft tissue masses
detect venous incompetence
document re canalized channels of collaterals

Question 2

to improve imaging for venous structures

Answer 2

adjust color scale to detect slower velocities
change wall filters
increase color gains

Question 3

with chronic venous insufficiency what do you normally see

Answer 3

flow reversal with valsalva which indicates venous reflux

Question 4

evaluation of chronic venous insufficiency

Answer 4

may use cuff inflation technique while scanning

with patient standing and bearing weight on the contralateral leg

Question 5

cuff sizes for venous insufficiency testing

Answer 5

thigh - 19 x 40cm
calf 12 x 40cm
foot 12 x 40cm

Question 6

rapid cuff inflator inflates

Answer 6

80 mmHg thigh
100 mmHg calf
120 mmHg foot

Question 7

with cuff at thigh, doppler flow direction and peak velocities are assessed

Answer 7

cfv and saphenofemoral junction

Question 8

with cuff at calf, doppler flow direction and peak velocities are assessed

Answer 8

PV and GSV

Question 9

with cuff at foot

Answer 9

PTV evaluated

Question 10

methods to identify venous reflux include

Answer 10

spectral analysis

color flow imaging

Question 11

spectral analysis with chronic venous insufficiency

Answer 11

reversed venous flow lasting more than 30 seconds to 1 minute

Question 12

color flow imaging and chronic venous insufficiency

Answer 12

color changed noted during prox compression maneuver or cuff deflation

Question 13

ivc and pelvic vein eval begins at

Answer 13

level of umbilicus in transverse

Question 14

eval of other abdominal vessels begins at

Answer 14

xiphoid process in transverse

Question 15

normal lower extremity doppler venous signals

Answer 15

spontaneity- signal heard at all sites except PTVs

Phasisity varies with respiration

Question 16

lower extremity phasicity

Answer 16

increase with expiration

decrease with inspiration

Question 17

upper extremity phasicity

Answer 17

decreased with expiration

increases with inspiration

Question 18

pulsatile venous flow can indicate

Answer 18

CHF

Question 19

pulsatile flow is normal in which vessels

Answer 19

subclavian and innominate veins

Question 20

with deep inspiration what happens to abdominal vessels

Answer 20

dilation

Question 21

what vessels in abdomen have bi-directional pulsatile doppler signals

Answer 21

ivc
renal veins
hepatic veins

Question 22

what vessels are minimally phasic with continuous doppler signals

Answer 22

portal vein
splenic vein
mesenteric vein

Question 23

if flow is not spontaneous at the CFV FV and /or pop veins

Answer 23

an obstruction distal to or at that site is suggested

Question 24

if flow is not phasic, but continuous

Answer 24

a proximal obstruction should be considered

Question 25

if no augmentation with distal compression is seen

Answer 25

obstruction between where you are compressing and where you are listening

Question 26

if flow increases during proximal compression

Answer 26

venous reflux

Question 27

rouleau formation is

Answer 27

sluggish flow seen as heterogenous material moving through vein with respiration and augment maneuvers

Question 28

rouleau formation may suggest

Answer 28

could be normal or could suggest prox obstruction

Question 29

acute thrombosis

Answer 29

non compressible
spongy thrombus of low level echoes
dilation of vessel
no filling on color flow

Question 30

chronic thrombosis

Answer 30

echogenic
collaterals
vessel not dilated

Question 31

flow characteristics of chronic venous thrombosis

Answer 31

abnormal doppler
continuous or decreases phasicity
venous reflux lasting longer than 30 seconds or longer than 1 minute

Question 32

color flow doppler of venous reflux

Answer 32

appears as a shift in color from flow away from probe to flow towards probe during valsalva or compression distal to transducer

Question 33

budd chiari syndrome

Answer 33

thrombosis of Hepatic veins, sinuosoids, or ivc

Question 34

clinical findings of budd chiari may include

Answer 34

hepatomegaly
abdominal pain
sudden ascites