UPPER LIMB DVT ULTRASOUND - Normal
Basic deep venous anatomy of the arm.
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Basic superficial venous anatomy of the arm.
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|The red line shows the subclavian vein origin scan plane.||Doppler of the Subclavian vein origin.
The Jugular vein pre & post compression.
Asking the patient to valsalva (or just 'puff their cheeks out') will help distend the neck veins.
|Other than the deepest portion of the axillary vein, the veins from the distal subclavian to the wrist should be readily compressible.
||The Axillary vein, pre & post compression.
|The vein is easily compressed so light transducer pressure is important.||Depending on arm movement and respiration, the Axillary and subclavian veins may appear pulsatile.
Transverse mid upper arm.
Hover mouse over to see the scan plane.
Transverse view of the Brachial and Basilic veins.
|An axial view of the upper arm vein anatomy.
Transverse view of the Brachial and Basilic veins and nerves of the upper arm.
The veins will be easier to assess with the patient erect to allow better venous distension. The patient will be comortable seated with a pillow under their arm for support and this allows for easy scanning access.
|Scan plane for the deep forearm veins.
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|The Radial artery and veins.||The Ulna artery and veins.|
To exclude or confirm the presence of deep and or superficial venous thrombosis as a cause of pain and swelling in the upper limb.
Patients with known altered coagulation status, on oral contraceptive pill, weight lifters, upper limb, neck or breast surgery or trauma are susceptible to clots in this region.
Obese patients, or those with severe oedema will limit the scan quality resulting in only being able to exclude occlusive thrombus Acoustic windows and detail may be limited in patients with open wounds/sutures.
The mid subclavian vein is obscured by the clavicle.
Use a mid frequency probe (5-8MHZ). Often using a curvi-linear probe is easier than a linear probe, particularly when doing compression views.
Low PRF (velocity) colour / power / Doppler settings with low wall filter when assessing veins with low velocity flow. Be prepared to change frequency output of probe (or probes) to adequately assess both superficial and deeper structures.
Non compressibility or filling defects with colour doppler.
Acute thrombus will be hypoechoic and difficult to see on B-mode without increasing your gain settings. It will generally slightly distend the vein and be focally tender. The thrombus propogates proximally with a 'tongue' projecting into the lumen at its moost proximal end. As the thrombus ages, it becomes more echogenic. Old, chronic thrombus will be echogenic, retracted from the vein walls with recanalised flow through and around it.
Examine the deep veins from the neck and brachiocephalic vein to the hand.
Patient supine on bed, arms by their side. Scan in transverse at the antero-lateral base of the neck. Using colour doppler, find the Jugular vein and follow inferiorly to the junction with the subclavian vein. Follow the subclavian vein laterally using colour doppler in both longitudinal & transverse planes to exclude non occlusive filling defects.
Patient still supine on bed with ipsilateral hand on their head, elbow flexed laterally to permit easy access to the axilla. Find the distal subclavian artery and follow through the axilla with colour doppler and compressing using b-mode in the transverse plane
As you reach the proximal arm, the axillary vein will divide into the basilic and brachial veins.
The basilic vein is the larger and is more superficial. Usually single but may be duplicated. Continue from the axillary vein checking in transverse that the basilic and brachial veins of the upper arm are compressible.
This may be best acheived with the patient sitting on the side of the bed with their arm supinated.
At the antecubital fossa, the brachial vein will divide into the radial & ulnar veins.
Still with the patient seated on the side of the bed, follow the radial and ulnar veins to the wrist confirming compressibility and flow.
As with the veins in the calf, the veins of the forearm genarally run in pairs (venous commantantes).
|For images of ARM DVT and associated pathology.
An upper limb DVT series should include the following minimum images
Document the normal anatomy. Any pathology found in 2 planes, including measurements and any vascularity.