Sonographic estimates of vein size in the lower extremities: subjective assessment compared with direct measurement

Popliteal vein aneurysm presenting as recurrent pulmonary embolism

Although rare, popliteal vein aneurysms can lead to pulmonary emboli, which can be fatal. We present a case of a popliteal vein aneurysm in a 39-year-old female who presented with her third episode of pulmonary embolism despite being on anticoagulants. Computed Tomography Venogram demonstrated a large Popliteal Vein Aneurysm measuring 71×36×77 mm which was surgically repaired. According to the current literature, anticoagulation is insufficient therefore early surgical intervention is recommended as it is safe and effective.

A three-dimensional electronic report of a venous echo color Doppler of the lower limbs: MEVeC®

BACKGROUND

The reports of ultrasound evaluation of lower limb veins are difficult to understand by general practitioners (GPs) and physicians who are not specialized. We developed software for a three-dimensional (3D) electronic report of venous hemodynamic mapping (MEVeC(®)) in order to represent lower limb venous vasculature in a 3D way. The aim of the study is to compare the novel 3D report with the standard report.

METHODS

Thirty subjects (medical students and GPs) evaluated a standard report and a novel 3D report of the lower limb veins of a prespecified patient. The cases were randomly and blindly taken from an archive of 100 cases. GPs and students answered a questionnaire made up of 13 questions that were structured in order to investigate the readability and comprehension of the two reports. A score ranging from 0 to 10 (0= not understandable; 10= full comprehension) was attributed to each report for each question according to the readability of the venous scheme proposed.

RESULTS

The scores from each question of the questionnaire were compared. The 3D report (MEVeC(®)) obtained higher scores than those from the evaluation of the standard report (P<0.0001). Each question revealed the superiority of the 3D report (MEVeC(®)) as compared with the standard report of the ultrasound evaluation of lower limbs. When dividing the scores according to percentiles, the 3D report (MEVeC(®)) still continued to show more readability than the standard report in a statistically significant way (P<0.0001).

CONCLUSION

The new 3D report (MEVeC(®)) concerning ultrasound evaluation of lower limb veins is more reproducible than the standard report when evaluated by medical physicians not specialized in the evaluation of the vein tree of lower limbs.

Chronic-Stage Deep Vein Thrombosis of the Lower Extremities

OBJECTIVE

To describe the computed tomographic (CT) findings of chronic deep vein thrombosis (DVT) and its evolution from acute DVT.

METHODS

Fifty-one consecutive patients with 52 legs confirmed as acute DVT by CT venography underwent follow-up computed tomography more than 2 months later. Follow-up CT findings were assessed retrospectively by consensus between 2 radiologists. The frequencies of CT findings were analyzed for affected venous segments: common iliac, external iliac, femoral, popliteal, and calf veins.

RESULTS

Twelve legs (23%) were completely normalized on follow-up computed tomography, but 40 legs (77%) showed abnormal findings as follows: luminal obliteration (n = 16), decreased caliber (n = 30), residual thrombi (n = 3), fibrotic bands (n = 28), ipsilateral muscle enlargement (n = 28), ipsilateral subcutaneous edema (n = 11), and superficial collateral vein development (n = 23). The external iliac vein (26/40, 65%) was the most commonly affected site followed in decreasing order by femoral (29/50, 58%), common iliac (9/18, 50%), popliteal (22/47, 47%), and calf veins (9/43, 21%). Trends were observed whereby luminal obliteration affected iliac veins and fibrotic bands affected femoropopliteal veins.

CONCLUSIONS

Luminal obliteration, decreased caliber, fibrotic bands, ipsilateral muscle enlargement, and superficial collateral vein development are common CT findings in chronic DVT of the lower extremity.