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Vascular/Cardiac » Peripheral Vascular
Tumor thrombus in the femoral vein
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Presentation A 45 year old woman presents with redness and edema of her right calf. An ultrasound was performed. She has no other complaints other than some pain around the right hip joint.
 
 
 
Caption: Sagittal view of a vessel in the groin
Description: The vessel appears dilated and is filled with echogenic material suggestive of thrombus. The vessel was not compressible.
 
 
 
Caption: Multiple views of the vessel in the groin
Description: The same vessel is noted again. The echogenic material is again seen distending the vessel.
 
 
 
Caption: Sagittal and transverse views
Description: The same findings observed again. The vessel is the femoral vein. The femoral artery is seen adjacent to the vein in the transverse view.
 
 
 
Caption: Color Doppler of the femoral vein
Description: Some flow is noted in the thrombosed vein.
 
 
 
Caption: Spectral analysis of the flow in thrombosed vein
Description: The flow that was detected in the thrombosed vein shows an arterialized waveform.
 
 
 
Caption: Spectral analysis of the flow in thrombosed vein
Description: Multiple flow channels demonstrating arterialized flow pattern are detected in the thrombosed vein.
 
 
 
Caption: Spectral analysis of the flow in thrombosed vein
Description: The multiple flow channels showing arterialized flow are observed again in the thrombosed vein.
 
 
 
Caption: Spectral analysis of the flow in thrombosed vein
Description: A small channel of recanalized venous flow is noted.
 
 
 
Caption: Spectral analysis of the flow in thrombosed vein
Description: Similar finding is noted again with multiple areas of arterialized channels observed in the thrombosed vein. These findings are more in favor of a tumoral thrombus rather than a simple venous thrombosis.
 
 
 
Caption: Axial CT scan of the groin
Description: A large lobulated soft tissue mass is seen in close proximity to the right iliac crest. This was proven to be a sarcoma.
 
Differential Diagnosis Tumor thrombus in the right femoral vein
 
Final Diagnosis Tumor thrombus in the right femoral vein
 
Discussion The presence of arterial flow inside a venous thrombus prompted the diagnosis of a tumor causing secondary venous thrombosis in this case. A search for the primary tumor lead to the discovery of the sarcoma involving the soft tissues around the right iliac crest.
 
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