Advanced imaging in acute and chronic deep vein thrombosis

Abstract

Deep venous thrombosis (DVT) affecting the extremities is a common clinical problem. Prompt imaging aids in rapid diagnosis and adequate treatment. While ultrasound (US) remains the workhorse of detection of extremity venous thrombosis, CT and MRI are commonly used as the problem-solving tools either to visualize the thrombosis in central veins like superior or inferior vena cava (IVC) or to test for the presence of complications like pulmonary embolism (PE). The cross-sectional modalities also offer improved visualization of venous collaterals. The purpose of this article is to review the established modalities used for characterization and diagnosis of DVT, and further explore promising innovations and recent advances in this field.

Keywords: Deep vein thrombosis (DVT); acute DVT; chronic DVT; computed tomography venography (CTV); magnetic resonance venography (MR venography).

Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Figure 1

Acute deep vein thrombosis on ultrasound. Gray scale ultrasound examination of left common femoral vein (CFV) demonstrates an enlarged (arrow in A), non-compressible vein (arrow in B) with low level intraluminal echoes. Corresponding color flow and spectral Doppler (C) suggests no flow within the vein.

Figure 2

Chronic recanalized deep vein thrombosis on ultrasound. Gray scale ultrasound examination of the right popliteal vein demonstrates echogenic venous wall and a compressible lumen with an eccentric linear area of echogenic material (arrow in A). Doppler flow is noted around this linear area of echogenic material.

Figure 3

Acute left superficial vein thrombosis seen on computed venous tomography as an intraluminal filling defect with perivenous stranding (arrow).

Figure 4

Patient with bladder carcinoma and recent onset priapism. Axial TOF sequence (A) shows lack of flow related enhancement within IVC (white arrow) with anterior abdominal wall collaterals (yellow arrows). Coronal reformatted MIP image (B) of TOF sequence shows flow within bilateral iliac veins with paraspinal collaterals (arrow) and non-visualization of IVC. Contrast venography image (C) shows a lack of enhancement within IVC with thrombus filling its lumen. No contrast enhancement was seen within the thrombus on arterial phase image (D). TOF, time of flight; IVC, inferior vena cava.

Figure 5

MR venography showing extensive thrombosis of the right common femoral (arrow in A, C) vein extending superiorly into the right external iliac vein (arrow in B).

Figure 6

Tumor thrombus. A patient with hepatocellular carcinoma shows a thrombus within IVC showing arterial enhancement (A) with washout on delayed phase (B) similar to the mass in the segment 7 of liver. Another patient with a large RCC arising from right kidney (C) shows a tumor thrombus in right renal vein (D,E; arrows) that shows FDG uptake on PET image (F).

Figure 7

Paget-Schroetter syndrome. Longitudinal ultrasound image (A) along right axillary vein shows slightly echogenic thrombus with lack of color flow. Axial TOF image (B) shows absence of flow related enhancement in axillary vein (arrow). Corresponding axial T2W SE image (C) shows loss of signal void within axillary vein. Post contrast axial (D) and coronal MRV images (E,F) are showing filling defects within axillary and subclavian veins. TOF, time of flight.

Figure 8

A 44-year-old male with history of alveolar rhabdomyosarcoma with SVC syndrome. Axial image from CT angiography done with left arm injection (A) shows a stenotic SVC with lack of contrast enhancement. There is retrograde contrast filling of azygous vein with anterior chest wall, mediastinum and paraspinal collaterals (yellow arrows). Venous phase image shows a non-enhancing thrombus in SVC (B). Coronal MIP images (C,D) shows collateral flow through azygous (yellow arrow), mediastinal (white arrow) and chest wall (red arrow) collaterals. The DSA image (E) with simultaneous injection into right brachiocephalic vein and right atrium show occlusion of SVC with collateral flow through azygous vein (arrow). SVC is stenotic with good collateral flow suggesting chronic occlusion.