Technique: Assess bilaterally — common femoral vein (CFV), femoral vein (FV), popliteal vein, posterior tibial, and peroneal veins. Add color Doppler and augmentation (distal compression to assess flow). Non-compressibility = DVT.
Acute vs Chronic DVT
| Finding | Acute DVT | Chronic DVT |
|---|---|---|
| Compressibility | Non-compressible; lumen does not collapse; may feel "spongy" | Non-compressible; firm, fibrotic; may be partially compressible with recanalization |
| Echogenicity | Anechoic or hypoechoic; fresh thrombus may be nearly invisible — Doppler essential | Heterogeneous; hyperechoic; wall thickening and fibrosis |
| Vein caliber | Enlarged and distended | Contracted, narrowed, or normal with recanalization |
| Color Doppler | Absent or markedly reduced flow; filling defect | Partial recanalization with flow around organized thrombus; collateral vessels |
| Augmentation | Absent with distal compression | Reduced or present with recanalization |
| Respiratory phasicity (CFV) | Absent phasic variation | May be absent or reduced |
Proximal DVT (CFV, FV, popliteal) = high PE risk — anticoagulation required. Report the level of proximal extent explicitly. Isolated distal (infrapopliteal/calf) DVT: serial CUS in 1 week if anticoagulation withheld; anticoagulate if high PE risk or symptomatic.
Misnomer: The "superficial femoral vein" is a deep vein — DVT here carries the same PE risk as CFV thrombosis and requires full anticoagulation. Use "femoral vein" in reports to avoid clinical confusion.
Reporting Checklist — DVT
- Veins involved: common femoral / femoral / popliteal / posterior tibial / peroneal / great saphenous — list all
- Laterality: right / left / bilateral
- Proximal extent: document most cephalad level of thrombus
- Free-floating thrombus: present / absent (increased PE risk — note prominently)
- Acute vs chronic: echogenicity, collaterals, wall thickening
- Compression documented at all levels examined
- IVC involvement: assessed / not assessed
Reference
Radiopaedia — Deep vein thrombosis