RadteraLower Extremity Venous Duplex (DVT)
USNo contrastVascular
Indications
- Suspected deep vein thrombosis
- Leg swelling / pain / erythema
- Suspected pulmonary embolism source
- Follow-up of known DVT
- Elevated D-dimer
Patient prep
- None
- Supine with leg externally rotated and slightly bent; reverse Trendelenburg or sitting helps venous filling for calf/distal
Contrast
None / non-contrast
Technique
- Linear transducer 5-7+ MHz (curvilinear for deep/large thigh)
- Transverse grayscale with compression every 1-2 cm — the primary test
- Color and spectral Doppler for flow, augmentation, phasicity, and respiratory variation
- Evaluate from inguinal ligament to popliteal trifurcation (and calf veins per protocol)
Series / Sequences
| # | Series / Sequence | Plane | Notes |
|---|---|---|---|
| 1 | Common femoral vein - compression | Transverse | Compressibility; include CFV/SFJ |
| 2 | Femoral vein (proximal/mid/distal) - compression | Transverse | Compress every 1-2 cm |
| 3 | Deep femoral vein (proximal) - compression | Transverse | Compressibility |
| 4 | Popliteal vein - compression | Transverse | Through trifurcation |
| 5 | Calf veins (posterior tibial, peroneal, gastrocnemius/soleal) per protocol | Transverse | Compression if symptomatic / complete protocol |
| 6 | Spectral Doppler CFV | Spectral | Phasicity, respiratory variation, augmentation |
| 7 | Color/spectral at representative levels | Long axis | Flow and augmentation |
Key points
- Vein compressibility (complete coaptation) in transverse is the primary diagnostic maneuver; non-compressibility indicates thrombus
- Compress at 1-2 cm intervals from inguinal ligament through popliteal trifurcation
- Loss of respiratory phasicity in CFV suggests proximal/central obstruction
- Document dual images (with/without compression) of CFV, FV, deep femoral, and popliteal veins
References
• AIUM Practice Parameter for the Performance of Peripheral Venous Ultrasound Examinations
• ACR Appropriateness Criteria: Suspected Lower Extremity Deep Vein Thrombosis
• Radiopaedia: Lower limb DVT link
• ACR Appropriateness Criteria: Suspected Lower Extremity Deep Vein Thrombosis
• Radiopaedia: Lower limb DVT link
Source: Researched — verify against your institution
Reference template — verify and adapt to your scanner, vendor and institution before clinical use. Not a substitute for clinical judgment.