0:00

So this is a, uh, a different case, a companion case,

0:05

uh, because I really want to stress this point.

0:08

So this was a 42-year-old woman who presented

0:11

with abdominal pain and left lower extremity swelling.

0:15

And about five years prior to her presentation

0:18

to the emergency department,

0:19

she had had a radical hysterectomy for cervical cancer.

0:25

So we did a, you know,

0:26

they requested a duplex venous ultrasound

0:29

of the lower extremity.

0:31

And in this particular case, all the vessels were patent.

0:36

So here is the right side again, by now, you know

0:41

what, I'm driving it right.

0:43

This, there is normal ity. This is an old case.

0:47

So we were doing augmentation at the

0:48

time, we don't do anymore.

0:50

So there is normal IC

0:51

for in the right external iliac vein in the right

0:54

common femoral vein.

0:56

And on the left side you can see

0:59

that there is very monophasic flow.

1:01

And if you have both sides to compare,

1:03

that's really so striking.

1:05

So I think it's important to always look at the

1:07

contralateral side, uh, at least one doppler spectrum,

1:10

which is a routine.

1:12

And then when we looked at the, at the vein itself, uh, the,

1:17

the right camera fain was compressing.

1:19

The left was also compressing.

1:21

It was a little hard to compress

1:22

'cause the patient had pain, but basically the veins

1:25

completely normal, normal size,

1:27

no e echogenic material within it.

1:30

So again, we said there is no DVT,

1:35

but because we saw this lack of ity,

1:39

we said, okay, well we don't see anything

1:42

but the patient needs a CT scan, uh,

1:45

to see if there is anything more centrally.

1:48

So again, just to recap, uh,

1:50

bilateral common femoral veins are compressible.

1:52

There is flow demonstrated in both, uh,

1:55

external iliac veins.

1:56

However, there is what's more important the dampen flow in

1:59

the left external iliac vein with lack of normal ity.

2:03

So let's look at the next step with the CT scan.

2:05

And here you can see on the axial images

2:10

as well as the corona images that the,

2:13

the vein itself is hidden, maybe a little compressed.

2:16

But what is really important,

2:18

this patient has a necrotic mass

2:20

in the left pelvic sidewall compressing

2:24

the external iliac vein.

2:26

And that is the cause

2:27

of the dampened flow in the left external iliac vein.

2:31

So in this particular case, if we hadn't paid attention

2:35

to this dampen flow,

2:37

we could potentially have sent a patient home

2:39

because we did not see a DVT.

2:42

And now this patient that turns out was lost to follow up

2:46

and unfortunately for her, what this was,

2:48

was a big metastatic nodal mass from

2:51

squamous cervical cancer.

2:52

And we know that, uh,

2:53

squamous cell metastasis are often aquatic

2:57

such as this node.

2:58

Okay? So very, very, very important to pay attention

3:02

to the Doppler spectrum.

3:04

And so this is basically

3:07

what we need is recognize the dampen flow on one side.

3:11

In a vein, you have

3:12

to think about a more central pathological process.