Fool the POCUS Teacher: Significant Unilateral Venous Sludge in Pregnancy
ePoster
Authors: Christine Firth, St. Joseph's Hospital and Medical Center, Creighton University School of Medicine - Phoenix
A case is presented of inaccurate DVT diagnosis by an experienced ultrasonographer with image review by an expert. Left lower extremity DVT POCUS evaluation showed hyperechoic opacification of the popliteal vein through the trifurcation. Compression appeared incomplete. Flow assessment and augmentation appeared supportive of DVT. Ultimately, the finding was shown to be venous sludging. In hindsight, inadequate compression was applied despite apparent sufficient compression of overlying tissues and slight arterial compression. Greater pressure was applied than that required to compress the right popliteal vein, potentially due to anatomical differences or an oblique angle. Color doppler was also less accurate on the handheld machine used than a cart machine, and is notably not required for diagnosis, nor is the augmentation maneuver reliable. Comprehensive review of specific pitfalls by organ system, particularly less classic or more extreme examples, are often not included in typical POCUS training. Knowledge of the appearance of rouleaux formation and sludging will assist in the accurate diagnosis of DVT or lack thereof. The clinical significance of venous sludging is not fully known, but the clinician should maintain a suspicion for adjacent DVT. Most importantly, basic ultrasound principles and technique should chiefly be relied upon for DVT diagnosis.
Academic Hospitalist, Vice Chair of Medicine for Innovation St. Joseph's Hospital and Medical Center, Creighton University School of Medicine - Phoenix Phoenix, United States