ultrasound in deep venous thrombosis
DESCRIPTION
Ecografia Doppler-valoarea diagnostica in TVP si in monitorizarea raspunsului terapeuticTRANSCRIPT
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Locul si rolul US Locul si rolul US in boala in boala
tromboembolicatromboembolica
Alexandru Andritoiu, MDSp. Militar Craiova
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AnatomieAnatomie
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Vv. Membrului superiorVv. Membrului superior
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Vv. Membrului pelvinVv. Membrului pelvin
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Metode de diagnostic Metode de diagnostic flebologicflebologic
• Clinic• D-dimeri• US• Venografie• Isotopi• Angio-CT/RMN
USUS• B-mode• Doppler color• Doppler spectral• Power-angio• B-flow• CEUS• Elastografie
FLEBOGRAFIA – ,,gold standard,,
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FlebografiaFlebografia
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Metoda izotopicaMetoda izotopica
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Tehnica USTehnica US
• Transductor linear (5-8 MHz)• Setting: Low-PRF (venous) Low-velocity flow• Pozitia pacientului- in decubit dorsal- in ortostatism- sezand la marginea patului
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US venoasa - NormalaUS venoasa - Normala
• Perete fin (fara adventice)
• Calibru variabil cu fazele respiratorii
• D creste la man. Valsalva
• Compresibilitatea venei
• Flux variabil cu fazele respiratorii
• Muzicalitate specifica
• Lipsa pulsatilitatii
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CompresibilitateaCompresibilitatea
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Flux venos-variatia cu respiratia
US Doppler pulsatFluxul venos diminua pana la aplatizare in inspir profund
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Manevra ValsalvaManevra Valsalva
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Diagnosticul US al trombozeiDiagnosticul US al trombozei
• Material ecogen endoluminal
• Lipsa compresibilitattii
• Lipsa variatiei respiratorii
• Doppler: fara flux
• Dificil de apreciat vechimea trombusului!
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Non-compressionNon-compression
TVP-VFC: la manevra de compresie nu se observa reducerea calibrului venei, lumenul fiind ocupat de un tromb ocluziv
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Tromboza Vv. m. superiorTromboza Vv. m. superior
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V. subclavieV. subclavie
• Cateter venos• Paraneoplazica
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Tromboza V axilaraTromboza V axilara
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Tromboza V. Jugulare int.Tromboza V. Jugulare int.
NV, M, 72 ani Neoplasm bronho-pulmonar apical
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Tromboza vv. m. pelvinTromboza vv. m. pelvin
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TVP-VFC/VFS proximalaTVP-VFC/VFS proximala
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TVP ax Fem-PoplTVP ax Fem-Popl
TVP-VFC dreapta TVP-V Poplitee dreapta Fara semnal Doppler
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Tromboza VFS distalaTromboza VFS distala
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TVP-V. popliteeTVP-V. poplitee
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US Doppler TVP-V. popliteeUS Doppler TVP-V. poplitee
Flux absent in vena popliteeFlux prezent in artera homolaterala
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Tromboza v. tibiale posterioareTromboza v. tibiale posterioare
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Edemul de stazaEdemul de staza
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TVP in situatii clinice particulareTVP in situatii clinice particulare
• Sarcina/trombofilie• Neoplazii• Arterite inflamatorii• Repaus prelungit la pat (Stroke, IMA)• Post chirurgical (pelvis, abdomen, ortopedie)• Cateterism venos• Droguri cu risc inalt• Medicamente cu risc pro-trombotic
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TVP paraneoplazica
TVP – VFC la un pacient cu neoplasm gastric
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Sarcina si TVPSarcina si TVP
Tromboza VFC stg-sarcina 24 sapt.
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Tromboza V. Jugulara IntTromboza V. Jugulara Int
FV, F, 43 ani, Hepatita cronica vir. C – in curs de tratament cu IFN
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Ocluzia comuna A+V politeeOcluzia comuna A+V politee
Arterita std. IV
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TVP - VCITVP - VCI
TVP -VCI
Pacient in varsta de 29 ani, sex M: -edeme masive ale mm. inferioare, cu debut brusc, dupa efort fizic intens
TVP -VFC TVP -VFS
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TVP VFC cu invazia crosei V.SafTVP VFC cu invazia crosei V.Saf
Varice pubiene
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TVP - V. iliacaTVP - V. iliaca
• T. Maria, 48 ani• Fibrom uterin• Tratament: Orgametril• Edem masiv m. inf. stg.
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TVP - V. iliaca com. stgTVP - V. iliaca com. stg
Confirmare Angio-RMN
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Rezolutia trombozeiRezolutia trombozei
• Clexane• Sintrom• Detralex• Contentie elastica
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TVP asociata gonatrozeiTVP asociata gonatrozei
Tromboza V. poplitee
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Tromboza v. cefaliceTromboza v. cefalice
Pacienta 38 ani, cu durere si cordon venos la nivelul bratului stg.Teste de trombofilie pozitive
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TEPATEPA
• SR, 20 ani• TVP Fem-Popl dr• TEPA sub tratament
Confirmare CT
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Sdr. Post-tromboticSdr. Post-trombotic
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TVP recanalizataTVP recanalizata
Incontinenta valvulara post-trombotica
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Vv. perforanteVv. perforante
Relatia topografica cu ulcerul varicos
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Varice trombozateVarice trombozate
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Refluxul venosRefluxul venos
Incompetenta valvulara- Manevra Valsalva- Compresia gambei
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Contrastul spontan vs. TVPContrastul spontan vs. TVP
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Elastografia TVPElastografia TVP
DS, F, 43 ani-TVP F-P dr. – la 2 sapt. de la debut (recidiva sub Sintrom)
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ConcluziiConcluzii
•US Doppler(+/- Elasto) in flebologie, reprezinta o metoda diagnostica utila in diagnosticul:
- trombozei venoase
- sdr. post-trombotic
- bolii varicoase
•Monitorizarea imagistica a raspunsului terapeutic