From the Guidelines
No follow-up imaging is required for the patient based on the current venous ultrasound report dated 4/15/25, as it shows no evidence of deep vein thrombosis (DVT) or superficial thrombosis in either lower extremity. The report indicates normal findings with compressible veins, spontaneous phasic flow, normal augmentation, and no intraluminal thrombus. While the left peroneal vein was not visualized, this is not uncommon in ultrasound studies and does not necessarily indicate pathology when other findings are normal, as supported by the Society of Radiologists in Ultrasound Consensus Conference recommendations for ultrasound in lower extremity deep venous thrombosis 1.
According to the guidelines, complete duplex ultrasound (CDUS) is the preferred venous ultrasound test for the diagnosis of acute DVT, and the current study's findings are consistent with this approach, showing no evidence of DVT or superficial thrombosis. The study's recommendation for a second examination to safely exclude undiagnosed calf DVT that may propagate proximally between studies does not apply in this case, as the initial study was negative for DVT and the patient's symptoms do not necessitate further imaging at this time 1.
However, if the patient continues to experience persistent or worsening lower extremity edema, further clinical evaluation would be appropriate to identify other potential causes such as lymphedema, venous insufficiency, medication side effects, or systemic conditions. The current ultrasound results are reassuring and rule out DVT as the cause of the patient's edema symptoms. Key points to consider in the patient's management include:
- Monitoring for signs of worsening edema or new symptoms
- Considering alternative causes of edema
- Clinical correlation of symptoms with ultrasound findings
- Potential for repeat imaging if clinical suspicion for DVT or other venous pathology arises in the future, guided by recommendations such as those from the Society of Radiologists in Ultrasound Consensus Conference 1.
From the Research
Findings and Impression
The patient's findings indicate no evidence for superficial thrombus or DVT in the lower extremities, with spontaneous phasic flow and normal augmentation noted, and no reflux demonstrated 2, 3. The veins are compressible without intraluminal thrombus, and no abnormal fluid collections are present.
Follow-up Requirements
Given the patient's history of edema and the findings, follow-up may be necessary to monitor for any changes or developments in their condition. The use of compression stockings may be beneficial in preventing postthrombotic syndrome and reducing edema, as suggested by studies 4, 5. However, the decision for follow-up should be based on the patient's individual needs and medical history.
Management and Treatment
The management and treatment of edema and venous insufficiency may involve the use of compression stockings, as well as other interventions such as skin care and topical treatments 2, 3. The patient's condition should be monitored, and adjustments to their treatment plan made as necessary.
Key Points
- No evidence for superficial thrombus or DVT in the lower extremities
- Compression stockings may be beneficial in preventing postthrombotic syndrome and reducing edema
- Follow-up may be necessary to monitor for changes or developments in the patient's condition
- Management and treatment should be based on the patient's individual needs and medical history
- Studies suggest the use of compression stockings can reduce the risk of DVT and edema 4, 5, 6