1. DVT

2. • Deep venous thrombosis (DVT) is the presence of coagulated
blood, a thrombus, in one of the deep venous conduits that
return blood to the heart.
• The thrombus may become fragmented or dislodged and
migrate to obstruct the arterial supply to the lung, causing a
potentially life-threatening pulmonary embolus (PE).

3. • lower-extremity DVT is the most common venous thrombosis.
• Over a few months the thrombus resolves, partial
recanalization occurs and collaterals develop.

4. predisposing factors for DVT
• Altered venous stasis,
• Injury of the vascular wall,
• Hypercoagulable state.
Events or conditions that alter the equilibrium of one or more of
these factors may produce DVT.

5. Signs and symptoms
• Swelling
• Pain
• Increased warmth
• Red or discolored skin

6. Diagnostic tools
• Ultrasound
• X-ray venography
• CT venography
• MR venography
• Nuclear studies

7. Ultrasonography
• Ultrasonography is the current first-line imaging examination
for deep venous thrombosis (DVT) because
• Relative ease of use,
• Absence of irradiation or contrast material.
• High sensitivity and specificity

8. Grey and color Doppler
features
• Incompressibility
• Loss of augmentation
• Visualization
• Doppler flow

14. limitations
Patient size
Experience of the technologist performing the examination.
The iliac and pelvic veins are not imaged consistently with
sonography.
Interposed bowel gas may compromise duplex sonographic
examination of central iliocaval veins.
False positive results
Femoral vein duplication

15. X-ray venography
• A venogram is an x-ray test that involves injecting x-ray
contrast material (dye) into a vein to shows how blood flows
through veins.

16. Benefits
• assess the status of a vein
• find blood clots
• assess varicose veins before surgery
• find a vein in good condition to use for a bypass procedure or
dialysis access
• stenting

17. Limitations
• Costly
• Time consuming
• Patient discomfort due to needle puncture
• Contrast agent
• Radiation exposure

18. Radiological features
• Acute thrombus :intraluminal filling defect in the contrast
opacified vein.
• In chronic DVT, recanalization can result in a linear filling
defect in the vein, sometimes termed the tram-track pattern.
The vein appears as if it were 2 small, paired veins.

22. Lower-extremity venogram shows a nonocclusive chronic thrombus. The superficial femoral vein (lateral
vein) has the appearance of 2 parallel veins, when in fact, it is 1 lumen containing a chronic linear
thrombus..

24. Computed Tomography
• The CT finding of intraluminal thrombus is documented as a
filling defect on a delayed contrast-enhanced scan.

25. CTV

28. Normal CTV of pelvis and legs

29. Shortnessofbreathina53-year-oldmanwithacutemyelogenousleukemia

30. M.R.I
• Specific indications
• Alternative to CT (particularly in patients with an allergy to
contrast material, in those with renal failure, and those in
whom an evaluation of the iliocaval veins are required for
questionable sonographic findings) or
• For a pre interventional evaluation of the extent of a
thrombus

31. limitations
• MRI cannot be used in patients with ferromagnetic implants
• Claustrophobia
• In general, MRI findings are subject to many artifacts that
simulate vascular disease.
• based contrast agents have been linked to the development of
nephrogenic systemic fibrosis (NSF) or nephrogenic fibrosing
dermopathy (NFD).

33. Magnetic resonance venogram (MRV) - axial view; A = lateral (transverse) sinus; B = sigmoid
sinus; C = confluence of sinuses; and D = superior sagittal sinus.

34. 38 yrs old lady presenting with
severe headache giving hx of oral
contraceptive pills

41. Nuclear Imaging
• Radiolabeled peptides that bind to various components of a
thrombus have been investigated.
• Tc. Apcitide.
Drawbacks.
• costly
• The radiation dose is 6.8 mSv, equivalent to lower-extremity
CTV.

44. 64yrs male heavy smoker

45. a67-year-oldmanwithcancerandsymptomsofsyncopeand
hypoxia.

46. Thank You