Thread by @RJonesSonoEM, Pt-Bilat LE pain/swelling 5 days.Prior hx of unprovoked DVT/PE years ago but [...]

Pt-Bilat LE pain/swelling 5 days.Prior hx of unprovoked DVT/PE years ago but off meds due to insurance. See thread. POCUS DVT #POCUS #IMPOCUS #FOAMed #FOAMus #MedEd #FOAMcc @ACEP_EUS @medpedshosp @cianmcdermott @jminardi21 @grepmeded @siddharth_dugar @msiuba @NephroP @SonoStache

What POCUS DVT protocol to use? 2-point or 3-point or extended? With or without Doppler? Meta-analysis showed good performance of 2 and 3 point POCUS but need to understand POCUS compression limitations if only compression used: https://pubmed.ncbi.nlm.nih.gov/31145304/?from_term=POCUS+dvt&from_pos=3">https://pubmed.ncbi.nlm.nih.gov/31145304/...

Comparison of 2-point and 3-point Point-Of-Care Ultrasound Techniques for Deep Vein Thrombosis at...

Both 2-point and 3-point POCUS techniques showed excellent performance for the diagnosis of DVT. We recommend that POCUS-trained attending emergency physicians perform the initial 2-point POCUS to...

https://pubmed.ncbi.nlm.nih.gov/31145304/?from_term=POCUS+dvt&from_pos=3

Adhikari and colleague article showed 6.3% false neg rate due to prox isolated DVT with 2-point compression. Limitations of POCUS prox compression DVT exam go beyond just missing isolated/focal DVT. https://pubmed.ncbi.nlm.nih.gov/25465473/ ">https://pubmed.ncbi.nlm.nih.gov/25465473/...

Isolated Deep Venous Thrombosis: Implications for 2-Point Compression Ultrasonography of the Lower...

In our study, 6.3% of ED patients with suspected deep venous thrombosis had isolated thrombi in proximal veins other than common femoral and popliteal veins. Our study results support the addition of...

https://pubmed.ncbi.nlm.nih.gov/25465473/

With Bilat symptoms need to think about proximal obstruction (IVC/EIV) or Bilat DVT.Potential to miss prox cause if Doppler not used to assess waveform.If study neg with bilateral symptoms, think proximal. Case of EIV DVT-Doppler used: @jminardi21 https://pubmed.ncbi.nlm.nih.gov/29849283/?from_term=POCUS+dvt&from_pos=7">https://pubmed.ncbi.nlm.nih.gov/29849283/...

Occult Iliac Deep Vein Thrombosis in Second Trimester Pregnancy: Clues on Bedside Ultrasound -...

Isolated pelvic deep vein thromboses (DVT) are rare and difficult to diagnose, but they are more common in pregnant women and carry an increased risk of embolization. Pulmonary embolism is the most...

https://pubmed.ncbi.nlm.nih.gov/29849283/?from_term=POCUS+dvt&from_pos=7

This patient had no thrombus seen in bilateral proximal compression scan from CFV to POP V (not 2 or 3-point). Rt proximal shown. Has spont echo contrast but no DVT. Do you stop here and pursue other diagnoses? Answer-No!

Doppler waveform obtained in R/L CFV. Showed monophasic waveform concerning for proximal obstruction (see image). There is loss of respirophasicity. Difficulty scanning EIV due to bowel gas but went to IVC next.

IVC TRV sweep-proximal to distal. Note IVC thrombus. Key point with POCUS compression exam: If negative but high suspicion or concern for proximal obstruction, get Doppler waveform and further imaging.

Great review article on IVC thrombus. Pt worked up-no IVC congenital abnormality or malignancy. Felt to be due to thrombophilia. Since thrombus acute underwent CDT https://interventions.onlinejacc.org/content/jint/9/7/629.full.pdf">https://interventions.onlinejacc.org/content/j...

One more article. This one on importance of monophasic waveform in CFV.

Latest Threads Unrolled: