0:01

Now this is a, a different case.

0:02

This is a 62-year-old man who presented with low extremity,

0:06

left lower extremity pain to the emergency department.

0:09

He was a poor historian in the history of substance abuse.

0:13

And basically they said, okay, as left lower extremity pain,

0:17

we are gonna get a left lower extremity venous doctor.

0:20

And he actually came twice.

0:22

He came once, uh, the, I'm not showing you this,

0:26

these images and uh, it was just read as no evidence

0:29

of event thrombosis.

0:30

But the patient had worsening pain. So he came again.

0:34

And this time again, uh,

0:35

these are the wonderful sonographer from Jus Hopkins

0:39

who you know, are really, uh, you know, really, uh,

0:42

I mean we have excellent sonographer at NYU too.

0:45

But this is a case from Hopkins where the sonographer said,

0:49

okay, well let's look at the left property chill vein.

0:53

Right? So the VIN is fine, the VIN is compressing.

0:58

But then she noticed that, oh my god,

1:01

what is going on in the artery?

1:03

The vein is clear here, but it seems like there is a clot.

1:06

There is filling the entire left popal artery.

1:11

And the way this is moving

1:14

that the vein should pull the artery, I'm sorry,

1:16

should pulse out like this and it's puls it in this way.

1:19

So that is a sign

1:21

that there is an occlusive clot in the left popal artery.

1:27

So basically what happened is that they had

1:30

maybe misinterpreted the patient's symptoms.

1:32

The patient didn't communicate what was wrong with him

1:36

and they just ordered the wrong study.

1:39

But fortunately, the second time it was picked up

1:42

that the patient had a clot

1:45

occlusive clot in the left paral artery.

1:48

So then we, we did a portion of the, the,

1:51

the arterial study.

1:53

And so this is the other side, the right side,

1:56

which shows a normal filling popal artery

2:00

with a normal phasic flow.

2:03

And then we looked at the dorsal is PS artery also nice

2:06

strong phasic flow.

2:09

When we looked at the popal artery,

2:10

there is no flow at the level of the clot.

2:13

And the left dorsal EDUs is extremely attenuated

2:17

with very low flow.

2:19

So the more of, so this patient ended up having, uh,

2:24

a completely a complete arterial Doppler examination in,

2:28

confirmed that a, a complete occlusion

2:29

of the distal left paral artery, uh,

2:32

and the patient had to have an emergency, uh, thrombectomy

2:37

and revascularization of that lower extremity.

2:40

Otherwise you would've potentially had, had

2:42

to have an amputation.

2:45

So the more of the story here is that it's important when

2:49

not to have tunnel vision,

2:51

but look around, uh, you know, basically our job is

2:54

to problem solve the patient, patient has symptoms or, or,

2:57

and we need to figure out why.