Duplex/Color flow venous imaging

Question 1

Sources for false positive?

Answer 1

• extrinsic compression: tumors, ascites, and pregnancy
• peripheral arterial disease: decreased venous filling
• chronic obstructive pulmonary disease: elevated central venous P
• improper Doppler angle or probe pressure
• superior vena cava syndrome

Question 2

Sources of false negative studies?

Answer 2

prox obstruction

technically limited studies

Question 3

May be difficult to thoroughly evaluate what peripheral veins in the lower extremity secondary to vessel size, depth, and course?

Answer 3

infra-popliteal

Question 4

Difficult to thoroughly evaluate what peripheral upper extremity veins secondary to bony structures?

Answer 4

subclavian and brachiocephalic/innominate

Question 5

What is the patient positioning for upper extremity peripheral vein?

Answer 5

supine or low fowlers position

arm in pledge position

Question 6

What settings can be adjusted to maximize color filling and flow patterns?

Answer 6

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

Question 7

What is another word for compressibility?

Answer 7

coaptation

Question 8

What are the possible venous flow patterns?

Answer 8

spontaneous, phasic, augment with distal compression, augment with proximal release

Question 9

Signal immediately heard at all sites except what vein?

Answer 9

posterior tibial

Question 10

what is the lower extremity phasicity?

Answer 10

increase with expiration and decreases with inspiration

Question 11

what is the upper extremity phasicity?

Answer 11

decreases with expiration and increases with inspiration

Question 12

pulsatile venous flow pattern evident with fluid overload or what?

Answer 12

congestive heart failure

Question 13

What is a technique to collapse the subclavian and innominate?

Answer 13

a quick breath through pursed lips should collapse vein

Question 14

Flow reversal usually in response to a valsalva maneuver or during prox manual compression indicates what?

Answer 14

venous refulx

Question 15

Reflux is identified when reversed flow last more than how long?

Answer 15

1 sec

Question 16

Deep inspiration causes the abdominal and pelvic veins what?

Answer 16

dilate

Question 17

Phasic, bi-directional/pulsatile Doppler signals are in what veins?

Answer 17

IVC, renal, and hepatic

Question 18

minimally phasic, continuous Doppler signals are in what veins?

Answer 18

portal, splenic, and mesenteric

Question 19

There is minimal flow fluctuation in the portal vein and flow is variable in the hepatic veins when?

Answer 19

during inspiration

Question 20

If flow is not spontaneous at the CFV, FV, and/or Pop V what could be the cause?

Answer 20

obstruction distal to or at the site

Question 21

If flow is not phasic, but rather continuous, what could be the result?

Answer 21

a proximal obstruction

Question 22

Where might an obstruction be if the is no augmentation with distal compression seen?

Answer 22

obstruction may be between where you are compressing and where you are listening, or slightly more proximal

Question 23

If there is no augmentation with proximal release, where might an obstruction be?

Answer 23

proximal

Question 24

If flow increases during proximal compression, what does that signify?

Answer 24

venous reflux

Question 25

A compressible vessel with evidence of rauleau formation on B-mode could be what?

Answer 25

normal or suggest proximal obstruction

Question 26

What is the appearance of chronic clot?

Answer 26

- highly echogenic - visible collateralization or recanalization may be evident - vessel not dilated; may retract over time

Question 27

Flow characteristics with chronic clot?

Answer 27

- abnormal Doppler venous signals may be evident, such as continuous, decreased phasicity, or no augmentation - venous reflux lasting >1 sec

Question 28

Where is an IVC interruption device usually placed?

Answer 28

below renal veins and may appear as bright echogenic lines

Question 29

With systemic venous hypertension what is evident?

Answer 29

persistent dilated vessels

Question 30

Increased portal venous pressure can result in what flow alterations?

Answer 30

- reversed flow in portal vein (hepato-fugal) | - collateral development

Question 31

What is Budd-Chiari Syndrome?

Answer 31

- results from hepatic occlusion | - primary site of obstruction may be hepatic vein, sinusoids, or IVC

Question 32

What are the clinical findings of Budd-Chiari Syndrome?

Answer 32

hepatomegaly, abdominal pain, sudden onset of ascites