This patient has a normal ultrasound of the deep veins of the lower extremity. However, the area to which he was most tender was along his medial thigh. At the point of the images and video, he had a small palpable knot. The resultant images indicate superficial thrombophlebitis.
Deep Venous Thrombosis
When evaluating a patient for DVT, we usually look only at the deep circulation of the leg. The superficial circulation joins with the deep veins to become the common femoral vein (CFV). Traditional ultrasound protocols scan through the CFV, the junction point with the saphenous vein, the profunda femoris and the superficial femoral vein (SFV), then look at the popliteal above the trifurcation in the calf, illustrating compressibility as they go. Compression ultrasound performed at 2 points only, CFV and popliteal, has been shown to have 100% sensitivity for DVT. Since DVTs never occur solely in the SFV, it is important to know that the CFV, and not the SFV, is visualized on the screen.
Superficial Thrombophlebitis
Superficial thrombophlebitis is characterized by a clot within the lumen of a superficial vein, which leads to inflammation of the walls of the vessels, as well as the surrounding tissue. It is most commonly found in varicose veins of the lower extremity but can proliferate up the venous circulation. If it extends through the greater saphenous vein into the common femoral vein, then it may become a deep venous thrombosis (rare). On Ultrasound the thrombosed vein wall appears thickened, lacks compressibility and may have a hyperechoic center, indicating clot.