Presentation
Lower limb swelling
Patient Data
Echogenic streaks are seen throughout the deep venous system in B-mode. There is also incomplete color filling in color Doppler mode. A significant reflux is seen in the popliteal vein during straining in pulsed wave mode. There is also reflux on the release of distal augmentation in both the saphenofemoral junction (SFJ) and the long saphenous vein (LSV). Multiple large-sized perforators are noted. Note the flow reflux through the perforator into the superficial system on augmentation. The LSV is seen with a large caliber.
Case Discussion
This is a case of secondary varicose veins on top of a recanalized deep venous thrombosis (DVT). Particular attention should be paid to the sonographic signs of old DVT. Echogenic streaks within the vein by B-mode, incomplete color filling by color Doppler, and reflux of flow on straining or release of distal augmentation by pulsed wave Doppler are all signs of chronic DVT. The extension of the DVT through the saphenofemoral junction leads to the incompetence of both the junction and the long saphenous vein following recanalization.
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