Is The Gold Standard in Venous Duplex Causing False Negative Exams?
Venous duplex ultrasounds are performed in the transverse and sagittal planes. Due to compression ultrasound being the gold standard most Sonographer's perform transverse compression first and focuson distal augmentation when assessing with Doppler. Most Sonographer's do not let the Doppler run and evaluate for phasicity or spontaneity the key indicators of a proximal obstruction.
When performing venous duplex ultrasound to evaluate for deep vein thrombus or DVT compression of the veins in the transverse plane is the gold standard. It has been well established that thrombus should be identified in both planes. Compression ultrasound combines real-time imaging of the deep veins with venous compression to diagnose deep vein thrombus.
To solve this problem we suggest evaluating with Doppler without augmentation allowing enough time to pass to evaluate phasicity and spontaneity. It adds one more picture to the exam and very little time in comparison of the value gained. This can be done at the beginning or after compression. We suggest looking at the Doppler first, there is a lot of information that can be seen that many miss.