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Locul si rolul US
in boala
tromboembolica
Alexandru Andritoiu, MD
Sp. Militar Craiova
Anatomie
Vv. Membrului superior
Vv. Membrului pelvin
Metode de diagnostic flebologic
• Clinic
• D-dimeri
• US
• Venografie
• Isotopi
• Angio-CT/RMN
US
• B-mode
• Doppler color
• Doppler spectral
• Power-angio
• B-flow
• CEUS
• Elastografie
FLEBOGRAFIA – ,,gold standard,,
Flebografia
Metoda izotopica
Tehnica US
• Transductor linear (5-8 MHz)
• Setting: Low-PRF (venous)
Low-velocity flow
• Pozitia pacientului
- in decubit dorsal
- in ortostatism
- sezand la marginea patului
US venoasa - Normala
• Perete fin (fara adventice)
• Calibru variabil cu fazele respiratorii
• D creste la man. Valsalva
• Compresibilitatea venei
• Flux variabil cu fazele respiratorii
• Muzicalitate specifica
• Lipsa pulsatilitatii
Compresibilitatea
Flux venos-variatia cu respiratia
US Doppler pulsat
Fluxul venos diminua pana la aplatizare in inspir profund
Manevra Valsalva
Diagnosticul US al trombozei
• Material ecogen endoluminal
• Lipsa compresibilitattii
• Lipsa variatiei respiratorii
• Doppler: fara flux
• Dificil de apreciat vechimea trombusului!
Non-compression
TVP-VFC: la manevra de compresie nu se observa reducerea calibrului venei,
lumenul fiind ocupat de un tromb ocluziv
Tromboza Vv. m. superior
V. subclavie
• Cateter venos
• Paraneoplazica
Tromboza V axilara
Tromboza V. Jugulare int.
NV, M, 72 ani
Neoplasm bronho-pulmonar apical
Tromboza vv. m. pelvin
TVP-VFC/VFS proximala
TVP ax Fem-Popl
TVP-VFC dreapta TVP-V Poplitee dreapta
Fara semnal Doppler
Tromboza VFS distala
TVP-V. poplitee
US Doppler TVP-V. poplitee
Flux absent in vena poplitee
Flux prezent in artera homolaterala
Tromboza v. tibiale posterioare
Edemul de staza
TVP in situatii clinice particulare
• Sarcina/trombofilie
• Neoplazii
• Arterite inflamatorii
• Repaus prelungit la pat (Stroke, IMA)
• Post chirurgical (pelvis, abdomen, ortopedie)
• Cateterism venos
• Droguri cu risc inalt
• Medicamente cu risc pro-trombotic
TVP paraneoplazica
TVP – VFC la un pacient cu neoplasm gastric
Sarcina si TVP
Tromboza VFC stg-sarcina 24 sapt.
Tromboza V. Jugulara Int
FV, F, 43 ani, Hepatita cronica vir. C – in curs de tratament cu IFN
Ocluzia comuna A+V politee
Arterita std. IV
TVP - VCI
TVP -VCI
Pacient in varsta de 29 ani, sex M:
-edeme masive ale mm. inferioare, cu debut brusc, dupa efort fizic intens
TVP -VFC TVP -VFS
TVP VFC cu invazia crosei V.Saf
Varice pubiene
TVP - V. iliaca
• T. Maria, 48 ani
• Fibrom uterin
• Tratament: Orgametril
• Edem masiv m. inf. stg.
TVP - V. iliaca com. stg
Confirmare Angio-RMN
Rezolutia trombozei
• Clexane
• Sintrom
• Detralex
• Contentie elastica
TVP asociata gonatrozei
Tromboza V. poplitee
Tromboza v. cefalice
Pacienta 38 ani, cu durere si cordon venos la nivelul bratului stg.
Teste de trombofilie pozitive
TEPA
• SR, 20 ani
• TVP Fem-Popl dr
• TEPA sub tratament
Confirmare CT
Sdr. Post-trombotic
TVP recanalizata
Incontinenta valvulara post-trombotica
Vv. perforante
Relatia topografica cu ulcerul varicos
Varice trombozate
Refluxul venos
Incompetenta valvulara
- Manevra Valsalva
- Compresia gambei
Contrastul spontan vs. TVP
Elastografia TVP
DS, F, 43 ani-TVP F-P dr. – la 2 sapt. de la debut (recidiva sub Sintrom)
Concluzii
• US Doppler(+/- Elasto) in flebologie,
reprezinta o metoda diagnostica utila in
diagnosticul:
- trombozei venoase
- sdr. post-trombotic
- bolii varicoase
• Monitorizarea imagistica a raspunsului
terapeutic

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