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Deep Vein Thrombosis Jonathan Fleurat Boston Medical Center Hue, April 2012

Emergency lectures - Dvt ultrasound

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Page 1: Emergency lectures - Dvt ultrasound

Deep Vein Thrombosis

Jonathan FleuratBoston Medical Center

Hue, April 2012

Page 2: Emergency lectures - Dvt ultrasound

Facts about DVTs

Lower-extremity DVT is the most common site

a prevalence of 1:1000 population

Source of 90% of acute PEs

cause 25,000 deaths per year in the US

Page 3: Emergency lectures - Dvt ultrasound

Venous AnatomySystem of pumps and valves

Page 4: Emergency lectures - Dvt ultrasound

RisksMORE COMMON

•Age (>65 years old)

•Immobilization >3 days

•Pregnancy/postpartum

•Major surgery < 4 weeks

•Long plane or car trips >4h

•Cancer

•Previous DVT

•Stroke

•Acute myocardial infarction

•Congestive heart failure

•Sepsis•Intravenous (IV) drug abuse•Oral contraceptives•Estrogens

•LESS COMMON•Nephrotic syndrome•Ulcerative colitis•Multiple trauma•CNS/spinal cord injury•Burns•Lower extremity fractures•Systemic lupus erythematosus (SLE) and the lupus anticoagulant

•Behçet syndrome

•Homocystinuria

•Polycythemia rubra vera

•Thrombocytosis

•Inherited disorders of coagulation/fibrinolysis

•Antithrombin III deficiency

•Protein C deficiency

•Protein S deficiency

•Prothrombin 20210A mutation

•Factor V Leiden

•Dysfibrinogenemias and disorders of plasminogen activation

•I

•Heparin-induced thrombocytopenia (HIT)

Page 5: Emergency lectures - Dvt ultrasound

PresentationLeg Pain in 50% as chief complaint (Homan’s sign)

Tenderness in 75%

Edema only if complete obstruction

Unilateral or bilateral (higher obstruction- iliacs)

Only 10% on pulmonary embolisms present classically

Page 6: Emergency lectures - Dvt ultrasound

Ultrousound Technique

Page 7: Emergency lectures - Dvt ultrasound

Popliteal Compression

Page 8: Emergency lectures - Dvt ultrasound

Thrombosis of Common Femoral Vein

Page 9: Emergency lectures - Dvt ultrasound

Hands on Time

Questions???