Venous Pathology

Question 1

Upper extremity signs and symptoms

Answer 1

Unilateral arm or hand swelling
Superficial palpable cord
Erythema
Pain and tenderness
Facial swelling or dilated chest wall collaterals
Suggestive of superior vena cava thrombosis

Question 2

Upper extremity patients may present with….

Answer 2

Indwelling catheters or history of venous catheters

Question 3

Asymptomatic patients

Answer 3

May be examined before central catheter placement or prior to pacemaker placement

Question 4

Upper extremity veins may also be evaluated in patients

Answer 4

Suspected of pulmonary embolism

Question 5

PE symptoms

Answer 5

chest pain, tachypnea, or tachycardia

Question 6

Virchow’s Triad

Answer 6

Venous stasis
Hypercoagulability
Vessel wall injury

Question 7

Upper extremity thrombosis more common due to

Answer 7

Injury to vessels wall

More frequent introduction of needles and catheters into arm veins

Question 8

what veins are commonly used for indwelling catheters

Answer 8

Subclavian and internal jugular veins

May be associated with upper extremity thrombosis

Question 9

PICCS may also be

Answer 9

A cause of thrombosis

Catheter is inserted through basilic or cephalic vein then positioned near right atrium

Question 10

Paget-Shrotter syndrome

Answer 10

Venous thrombosis associated with compression of subclavian vein at the thoracic outlet
AKA effort thrombosis
Typical patients are young, athletic, and muscular males

Question 11

What are risk factors for thrombus

Answer 11

Trauma
Immobility or paralysis
Prior DVT
Recent major surgery
Cancer or chemotherapy
Family history
CHF
Pregnancy
Oral contraceptives
Hypercoagulability
Prolonged bed rest

Question 12

Acute thrombus

Answer 12

Is uniform in texture, with low-level echoes that may be difficult to visualize

• Is soft, or slightly compressible
• Is poorly attached; may sometimes “flap about” within the vessel
• Distends the vessel

Question 13

Chronic Thrombus

Answer 13

Is heterogeneous, with bright echoes
•Does not compress
•Is rigidly attached
•Tends to contract the vessel and may show a partial recanalization of the vein with a tortuous flow channel with well-developed collateral circulation

Question 14

Superficial venous thrombus

Answer 14

Diagnosed clinically with a painful superficial cord with surrounding erythema

Question 15

Venous insufficiency

Answer 15

AKA Reflux
Incompetent valves
Allows retrograde flow
Veins enlarge due to pressure increase
Can become infected
Postphlebitic syndrome aka postthrombotic syndrome

Question 16

How can venous insufficiency be tested

Answer 16

Valsalva; competent if flow stops; doppler signal stops

Question 17

Varicose veins

Answer 17

Damaged valves
Leaking  venous distention 
Spider veins
Bulging, superficial veins sometimes seen under skin
Primary and secondary varicose veins
Advanced age, obesity, family hx

Question 18

How can varicose veins be treated

Answer 18

Stripping, injections, lasers, radiofrequency

Question 19

Phlegmasia cerulea dolens

Answer 19

“PCD”
Cerulea = Blue
From severe acute dvt
Proximal outflow of limb blocked  blood pools  becomes blue
Untreated  gangrene, phlegmasia alba dolens, limbs amputation, death

Question 20

When does PCD usually occur

Answer 20

Men more than women

Question 21

PCD is strongly correlated to

Answer 21

Malignancy

Question 22

What are risk factors of PCD

Answer 22

hypercoagulable state
venous stasis
contraceptive use

Question 23

PAD results from

Answer 23

Untreated PCD

Question 24

Phlegmasia Alba Dolens

Answer 24

“Alba” means white
Results from untreated PCD where massive dvt compresses adjacent artery
Causes artery to vasospasm or constrict
Blood flow to limb decreases  turn white
Rare
High amputation and mortality rate

Question 25

Phlegmasia alba dolens sonographically

Answer 25

artery deformed appearance, low colour Doppler signal, and abnormal arterial waveform

Question 26

May thurner syndrome

Answer 26

2% to 23% of Le DVT case
Aka iliocaval compression syndrome
Mild to severe

Question 27

Who is may thurner syndrome seen in

Answer 27

Young women

Question 28

May thurner syndrome is caused by

Answer 28

Mostly compression left iliac vein between right iliac artery and spine or pelvic brim

Question 29

what does may thurner syndrome do?

Answer 29

Causes web-like adhesions which occlude vein (also the webs can filter and help prevent PE)
Treated with anticoagulants, therapy stents, and bypass grafts

Question 30

Differential diagnosis-pain and swelling lower extremities

Answer 30

Popliteal cysts, also known as Baker or synovial cysts
Ruptured popliteal cysts
Pseudoaneurysms, most often related to trauma
Popliteal artery aneurysm
Hematoma and/or muscle injuries (tear or rupture)
Lymphedema, due to obstruction of lymphatic system
Cellulitis