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