Yes. It sometimes can be seen in the femoral vein and sapheno-femoral junction (more rare in saphenous vein) during duplex scanning. Some clinicians consider that it is an indicator of impending venous thrombosis.
I have no hard data on this, but I notice it more often than not, so I cannot imagine it might be an indicator for (impending) venous thrombosis.
I'm agree. I also cant find a correlation of this phenomenon with thrombosis. To my opinion it is associated with high volume / low velocity venous reflux. The mean diameter of sapheno-femoral junction among patients with spontaneous contrast in CFV according to my prospective registry is 13,7 mm vs 9,73 in patients without any visible echos. However, I can not find any practical application of this finding.
Not necessarily reflux. You may also see it in fast turbulent flow conditions like in the internal jugular vein and in the recumbent patient in the proximal saphenous also during orthograde flow.
Thank you Dr. Bruijninckx!
If I understand your position correctly, you suppose that spontaneous echo-contrast of venous flow is just a consequence of significant flow disturbances (turbulence, stratification of flow in more layers with different velocity etc) and can be ignored from clinical point of view? Probably in veins with large diameter this phenomenon is just more visible during US scanning. It can be an good explanation of my observation. Thank you again.
HI,
I agree this observation does not indicate any abnormality. With a good B-mode, as we have nowadays, you can 'see' slowly flowing venous flow nicely in black and white ultrasound, particularly with the patient in standing position. Also, in areas where there is a valve, you can see sluggish material in the sinus of the valve, where the flow is slower, so you can actually ' see' the venous stasis with the ultrasound. Logically, where the vein is larger, flow is slower so the lumen gets more echogenic. At the SFJ, in case of a large SFJ, you can see the blood almost standing still in large GSV' s. Typically, if you look at a muscular vein e.g. a gastrocnemius vein in standing position, you may see a quite echogenic lumen. If you have the patient then do some tiptoes, or you do svereal calf squeezes, you'll immediately see that the lumen of the vein becones completely black, because you enhanced temporarily venous flow. If you wait for some minutes, it will again become more sluggish and echogenic.
It' s fun to look with B-mode ultrasound at our patients with CVD, the youngsters are always tempted to us colour at all times, but B/W can learn you a lot!
My best regards to both of you :-)
Marianne
in many cases this does not necessarily mean abnormality may be atheroma plaques, the valve sinuses and other artifacts. However, combined with the color mode, you can distinguish if indeed corresponds to a thrombus.
It is interesting to study these very frequent findings.
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