Morrison’s Pouch: case 1.1

morrisons-pouch-redo2A 75-year-old woman presents with left lower extremity swelling and pain behind the knee for the past few days.  She has been taking ibuprofen and was referred from her PMD, who was concerned that she may have a DVT.  The patient has a history of hypertension and diabetes.  She smokes cigarettes daily.   Her vital signs are within normal limits.  On physical exam, her legs are symmetric in size, her dorsalis pedis pulses are 2+ and symmetric, there is no erythema, but she is tender to palpation in the popliteal fossa.

You decide to ultrasound her lower extremity and obtain the following images.

Ultrasound 1

Ultrasound 2

Questions:

1.  What is the diagnosis?

2. Which veins of the lower extremity are visualized in the DVT examination?

3. Name a fiding seen on ultrasound exam that is consistent with the diagnosis of DVT?

Please post your answer in the “reply box” or click on the “comments” link  You will not see your answer post until next week when all of the submitted answers will be posted.  Good luck!

This case prepared by Dr Sam Lee, PGY-1 Emergency Medicine Resident, Detroit Receiving Hospital

“Morrison’s Pouch” is an educational module that utilizes ultrasound video clips from case presentations in the Emergency Department.  The section is hosted by Dr. Daniel Morrison, Director of Emergency Medicine Ultrasound for Detroit Medical Center, and case presentations are submitted by the EM residents of Detroit Receving Hospital.

2 Responses

  1. 1.DVT
    2. confluence of saphenous and common femoral following common femoral. poplateal to confluence of vessel.
    3. nocompressible vein most fo the time with a hypoechoic mass in the lumen.

  2. 1) DVT
    2) Politeal veins, common femoral and superficial femoral veins, greater saphenous veins, anterior and posterior tibial veins and peroneal veins
    3) Inability to compress the vein secondary to a DVT present

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