Presentation
An esophageal cancer patient on management for tuberculosis presents with bilateral lower limb swelling left more than right, discoloration, and left ankle pain.
Patient Data
Rigid hyperechoic material is seen in the lumen of the common femoral, superficial femoral vein, deep femoral vein, and popliteal vein.
The veins are not compressible and lack flow augmentation when the ipsilateral calf is squeezed.
There is no flow demonstrated on color Doppler, with increased flow within the perforator and superficial branches.
Diffuse subcutaneous edema of the ankle and foot region is seen due to cellulitis.
Also noted is atheromatous calcification of the femoral and popliteal arterial walls, suggesting of peripheral arterial disease.
Case Discussion
Deep venous thrombosis most commonly occurs in the lower limb venous systems; however, the deep neck and upper limb veins can also be affected.
Among the risk factors for deep venous thrombosis are age, with a two-fold increase in risk every 10 years, and malignancy, with a 4 to 6-fold increase in risk. The above patient was in her fifth decade of life and had a known case of esophageal cancer.
The initial imaging modality of preference for DVT diagnosis is duplex ultrasound. It is non-invasive, less expensive, readily available, doesn't use radiation or nephrotoxic contrast chemicals, can be done at the bedside, and is a reproducible procedure with good sensitivity and specificity.
Cellulitis is an acute infection of subcutaneous tissue resulting in edema, pain, and discoloration. Subcutaneous edema on sonography is seen as anechoic striations with a cobble-stone appearance.
Peripheral arterial disease is suggested by the presence of atheromatous calcifications in the arterial walls. A dedicated arterial Doppler study to quantify diameter and surface area reduction due to stenosis with or without ankle brachial index (ABI) is recommended.
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