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Evaluation of Leg Pain and Swelling

  • Christopher Gelabert
Chapter

Abstract

Point-of-care ultrasound for the assessment of leg pain and swelling is a rapid, high-yield assessment that can quickly lead to therapeutic interventions. Ultrasound of the lower extremity can be used to assess for deep venous thrombosis (DVT), lymphadenopathy, and visualization of subcutaneous edema for evaluation of cellulitis versus congestive heart failure (CHF). As most pathology in the lower extremity is relatively superficial, a high-frequency linear transducer is used for its superior linear resolution and flat footprint.

Keywords

Deep venous thrombosis Lymph node Cellulitis Congestive heart failure Edema 

Supplementary material

Video 40.1

This video demonstrates proper compression technique in the upper leg. Note the thin walls of the venous structures fully collapse under compression, while the thicker walled arteries resist compression. It is imperative that the transducer be held perpendicular to the skin for proper compression and visualization of the vascular structures during compression. Courtesy of Christopher Gelabert (MOV 4937 kb)

Video 40.2

Continued sequential compression is performed distally along the femoral vein until the vein courses into the adductor canal. Note the non-compressible femoral artery coursing alongside the femoral vein. Courtesy of Christopher Gelabert (MOV 11445 kb)

Video 40.3

This video demonstrates proper compression through the popliteal fossa with complete collapse of the popliteal vein and pulsatile movement of the popliteal artery. Courtesy of Christopher Gelabert (MOV 6383 kb)

Video 40.4

Visualization of the thrombus in the common femoral vein extending into the greater saphenous vein with lack of compressibility. Courtesy of Christopher Gelabert (MP4 8796 kb)

Video 40.5

Color Doppler and compression ultrasound reveal normal compression of the popliteal vein, but echogenic thrombus extending from the trifurcation into the popliteal vein. Courtesy of Christopher Gelabert (MP4 5373 kb)

Video 40.6

Scanning across a lymph node demonstrates that it is a finite structure while color doppler facilitates its distinction from vasculature. Courtesy of Christopher Gelabert (MP4 6422 kb)

Video 40.7

Video clip of cobble-stoning in the lower extremity with increased thickness of the subcutaneous layer. Courtesy of Christopher Gelabert (MP4 4188 kb)

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Emergency MedicineUT Health San AntonioSan AntonioUSA

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