Venous B-Mode-Doppler

B-mode Imaging Criteria

1. Normal vein

a. Fully compressible

b. No intraluminal echoes

c. Variation of vessel size with respiration/Valsalva maneuver

d. Vein is not dilated/constricted

2. Acute thrombus

a. Lightly echogenic

b. Homogeneous

c. Poorly attached or free floating

d. Spongy texture

e. Dilated vein (when totally obstructed)

f. Smooth borders

3. Chronic thrombus

a. Brightly echogenic

b. Well attached

c. Rigid texture

d. Contracted vein (when totally obstructed)

e. Irregular borders

f. Large collateral veins adjacent to obstruction

Doppler Criteria

1. Normal flow

a. Spontaneous

b. Phasic (changes with respiration)

c. Augment with compression and release

d. Competent (no reflux with compressions)

e. Non-pulsatile

2. Abnormal flow

a. Lack of spontaneous flow

i. Suggests occlusion 

ii. May be normal in distal veins Continuous flow

b. No respiratory variation in the waveform - suggests proximal thrombus or extrinsic compression

c. Lack of or decrease in augmentation with compression maneuvers, suggests obstruction between site of manual compression and transducer.

d. Valve incompetence (see chart for diagnostic criteria)

e. Pulsatile flow

i. Suggests right sided heart compromise if noted bilaterally and throughout extremity

ii. Suggests arterial-venous connection if unilateral 

iii. Pulsatile flow in upper extremity central veins is normal due to proximity to the heart (radiation of the cardiac pulse)