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Deep Venous Thrombosis

Spectrum of Findings and Pitfalls in Interpretation on CT Venography

Kavita Garg1 and Jie Mao

1 Both authors: Department of Radiology, Veterans Affairs Medical Center and University of Colorado, 1055 Clermont St., Denver, CO 80220.



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  		Fig. 1A. —Acute deep venous thrombosis in 72-year-old man suspected of having pulmonary embolism. Axial CT venogram shows nonoccluding intraluminal filling defect in inferior vena cava.

 


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  		Fig. 1B. —Acute deep venous thrombosis in 72-year-old man suspected of having pulmonary embolism. Axial CT venogram shows intraluminal filling defect (arrow) in left common iliac vein at its confluence with right iliac vein.

 


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  		Fig. 1C. —Acute deep venous thrombosis in 72-year-old man suspected of having pulmonary embolism. Axial CT venogram shows nearly occluding filling defect in left common femoral vein (arrowhead) with enhancement of its walls.

 


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  		Fig. 1D. —Acute deep venous thrombosis in 72-year-old man suspected of having pulmonary embolism. Axial CT venogram shows occluding intraluminal filling defect in right popliteal vein. Thrombosed popliteal vein (arrow) shows increase in caliber.

 


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  		Fig. 2. —Acute deep venous thrombosis in 48-year-old man with amputation below knee of right leg. Axial CT venogram shows intraluminal defects (arrows) with enhancing walls in right superficial and deep femoral veins. Right thign musculature is atrophic.

 


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  		Fig. 3A. —Focal wall thickening mimicking acute deep venous thrombosis in 66-year-old man suspected of having pulmonary embolism. Axial CT venogram shows nonoccluding defect (arrow) along posterior aspect of right common femoral vein.

 


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  		Fig. 3B. —Focal wall thickening mimicking acute deep venous thrombosis in 66-year-old man suspected of having pulmonary embolism. Longitudinal color Doppler sonogram (shown here in black and white) or right common femoral vein shows thickening of posterior wall (arrowheads) consistent with chronic deep venous thrombosis. This finding was unchanged compared with previous sonogram obtained 6 months earlier.

 


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  		Fig. 4A. —Chronic deep venous thrombosis in 74-year-old man undergoing dialysis because of chronic renal failure. Axial CT venogram obtained at level of inguinal ligament shows calcified thrombi in common femoral veins (arrows).

 


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  		Fig. 4B. —Chronic deep venous thrombosis in 74-year-old man undergoing dialysis because of chronic renal failure. Axial CT venogram obtained 2 cm superior to A shows intraluminal filling defect in left common femoral vein, which suggests acute thrombus (arrow).

 


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  		Fig. 4C. —Chronic deep venous thrombosis in 74-year-old man undergoing dialysis because of chronic renal failure. Transverse sonogram of left common femoral vein shows intraluminal echogenic material without shadowing (arrow). Vein was not compressible. It is known that thrombus echogenicity is not an accurate criterion for determining age of venous thrombosis.

 


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  		Fig. 4D. —Chronic deep venous thrombosis in 74-year-old man undergoing dialysis because of chronic renal failure. Longitudinal sonogram shows some flow in left common femoral vein and monophasic waveform that does not decrease to baseline with inspiration. Lack of changes with respiration suggests iliac vein obstruction.

 


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  		Fig. 4E. —Chronic deep venous thrombosis in 74-year-old man undergoing dialysis because of chronic renal failure. Axial CT venogram of right distal superficial femoral vein shows intraluminal calcification in otherwise normally enhancing vein (solid arrow). Three smaller venous collaterals (open arrows) surrounding artery are also seen. Calcification and collateral veins were not revealed on sonography, but right superficial femoral vein wall thickening was shown only on sonography (not shown).

 


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  		Fig. 5A. —Acute and chronic venous thrombosis in 64-year-old man with small cell lung carcinoma. Axial CT venogram shows small heterogeneously enhancing right superficial vein (straight arrow), acute thrombus in greater saphenous vein (curved arrow), and large profunda vein (arrowhead).

 


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  		Fig. 5B. —Acute and chronic venous thrombosis in 64-year-old man with small cell lung carcinoma. Longitudinal sonogram using color Doppler of proximal right thigh shows recanalized small superficial femoral vein (arrowheads) and capacious profunda vein shown in black and white (arrow) with normal flow. Valvular incompetence indicated by reversed flow on spectral waveform during Valsalva's maneuver was also noted (not shown).

 


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  		Fig. 6. —Flow artifact on CT venogram in 64-year-old man suspected of having pulmonary embolism. Axial CT venogram shows apparent filling defect (arrow) in left common femoral vein. Complete compressibility of this vein was seen on sonography (not shown). Flow artifacts are caused by inadequate delay before scanning. These artifacts are commonly seen on CT venograms in patients with significant peripheral artery disease, even with longer delay.

 


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  		Fig. 7. —Beam hardening artifact on CT venogram in 75-year-old man suspected of having pulmonary embolism. Axial CT venogram of right superficial vein shows apparent sharply demarcated filling defect (arrow) caused by superficial femoral artery calcification.

 


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  		Fig. 8. —Anatomic variation of deep venous system in 50-year-old man suspected of having pulmonary embolism. Axial CT venogram shows duplicated right superficial vein (open arrows) and dominant profunda femoral vein on left (solid arrow). Duplicated superficial femoral vein is common anatomic variation. Duplicated venous segments may be seen on one image or on multiple contiguous images.

 

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