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Detecting Pelvic Disease With Duplex Ultrasound. Ron Bush, MD, FACS Midwest Vein & Laser Center Dayton, Ohio. Why is a Scan Being Performed?. Varicose veins Swelling Possibility of DVT Venous claudication Pelvic symptoms. Consider.

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detecting pelvic disease with duplex ultrasound

Detecting Pelvic Disease WithDuplex Ultrasound

Ron Bush, MD, FACS

Midwest Vein & Laser Center

Dayton, Ohio

why is a scan being performed
Why is a Scan Being Performed?
  • Varicose veins
  • Swelling
  • Possibility of DVT
  • Venous claudication
  • Pelvic symptoms
consider
Consider
  • An ultrasound (US) of the pelvis includes an US of the femoral vein
  • Abnormal femoral US occurs frequently in pelvic compression or obstruction
  • Phasic flow is the normal pattern on doppler US
ultrasound findings cardiac
Ultrasound Findings: Cardiac
  • Back and forth pulsatile flow (roller coaster) on US may indicate:
      • ASD
      • Tricuspid regurgitation
      • AV fistula
ultrasound findings obesity
Ultrasound Findings: Obesity
  • Alteration in normal flow pattern
  • May be evidence of reflux at femoral & popliteal level
  • Usually symmetric
  • Often overlooked as cause of venous hypertension of the extremities
ultrasound findings acute thrombus
Ultrasound Findings: Acute Thrombus
  • No flow signal or monophasic pattern may be present
  • Non-compressibility of the iliac and/or femoral vein
  • Acute symptoms usually present
nutcracker syndrome
Nutcracker Syndrome
  • Left renal vein compression between the aorta and superior mesenteric artery
  • Can lead to pelvic congestion syndrome
  • May be associated with greater saphenous vein (GSV) insufficiency through collaterals
  • May present with unusual pattern of varices on thigh or leg
gluteal varicosities
Gluteal Varicosities

(Bush Venous Lectures, 2011)

ultrasound of lrv compression
Ultrasound of LRV Compression

(Bush Venous Lectures, 2011)

ultrasound findings nutcracker syndrome
Ultrasound Findings: Nutcracker Syndrome
  • Stenosis evaluated by comparing the anterior posterior (AP) diameter of the left renal vein (LRV) on left side of the aorta and at level of stenosis
  • Ratio of AP diameter and ratio of peak velocities should be used as US criteria for stenosis
may thurner syndrome
May-Thurner Syndrome
  • Compression of left iliac vein by right common artery
  • May be associated with leg swelling, varicosities, or iliac vein thrombosis with resultant sequalae
unilateral leg swelling
Unilateral Leg Swelling

(Bush Venous Lectures, 2011)

ultrasound findings may thurner syndrome
Ultrasound Findings: May-Thurner Syndrome
  • Evidence of compression
  • Monophasic flow may be present distal to obstruction
  • High velocity flow at area of stenosis
ovarian vein reflux
Ovarian Vein Reflux
  • Manifestations may Include
      • Pelvic congestive syndrome
      • Vulvar varices
      • Inguinal or thigh varices
      • Ovarian vein > 4mm
vulvar vein
Vulvar Vein

(Bush Venous Lectures, 2011)

conclusion
Conclusion

Any of the following should alert you to altered flow patterns in the pelvic veins:

  • Varicosities in unusual locations
  • Unilateral leg swelling
  • Acute thrombosis of the iliac vein
  • Reflux or monophasic flow on femoral US
  • Vulvar varices
references
References

Thombosis femoral vein image. Retrieved May 7, 2011 online from http://www.answers.com/topic/deep-vein-thrombosis.

Nutcracker image. Retrieved May 7, 2011 online from www.phlebolymphology.org/2009/07/nutcracker-syndrome/

Kim SH, Cho SW, Kim HD, Chung JW, Park JH, Han MC. Nutcracker syndrome: diagnosis with Doppler US. Radiology. 1996;198:93-97.

Leg image. Retrieved May 7, 2011 online from http://www.bushvenouslectures.com/blog/content.asp?id=348Oguzkurt L, Ozkan U, Tercan F, Koc Z, Sadick N, Trelies, M. A clinical histological and computer-based assessment of the Polaris LV, combination diode, and radio frequency system for leg treatment. Diagn Interv Radiol 2007;13:152-155.