Ultrasound Worksheet of Lower Limb Veins

Patient’s initial & number: Radiologist:

Date: Signature:
Table 1. List of sonographic findings of lower limb veins
(Tick the corresponding number based on findings [√], see table 2 for reference)
List of Veins Right Left
1 2 3 4 5 1 2 3 4 5
A Common femoral
B Junction of the common femoral with the great saphenous
C Proximal deep femoral
D Superficial femoral (proximal, mid, distal)
E Popliteal
F Anterior tibialis (proximal, mid, distal)
G Posterior tibialis (proximal, mid, distal)
Note:

Conclusions:

Table 2. Sonographic findings suggesting deep vein thrombosis

No : Findings
1 Lack of complete compressibility of vein*
* Beware: a normal femoral vein in adductor canal region may not compress
2 Visualization of intraluminal thrombus with complete or partial obstruction of the vein lumen
3 Distention of the vein compared to the adjacent artery
4 Abnormal venous Doppler signals, i.e. continuous non-phasic flow, reduced or absent flow with distal augmentation, or no obtainable signal
5 Continuous, non-phasic flow in CFV unilaterally, with phasic flow in contralateral CFV, suggesting iliac vein outflow obstruction, i.e. DVT of extrinsic
compression
Reference : Zwiebel WJ. Ultrasound diagnosis of venous thrombosis. In: Zwiebel WJ, Pellerito JS. Introduction to vascular ultrasonography. 5th ed. Philadelphia : Elsevier Saunders; 2005. Chapter 24;
p.449-65.

This form is a supporting document to the Doppler USG report. Version 2