Clip 1: Compression ultrasound of the common femoral / saphenous vein junction revealed non-compressible, hyper-echoic clot. Color flow seen here lighting up the common femoral artery.
Clip 2: Compression ultrasound of the popliteal vein showing a non-compressible, hyper-echoic clot in the vein. The hypo-echoic vessel seen deepest on the screen is the popliteal artery.
A middle aged male presented with sudden onset of severe leg pain. Significant medical history of metastatic prostate cancer on chemo. He looked ill, and his left leg was diffusely edematous and cyanotic.
Compression Ultrasound (CUS): showed extensive thrombus involving both the common femoral / saphenous vein junction (clip 1) and popliteal vein (clip 2). Phlegmasia Cerulea Dolens was diagnosed based on both POCUS findings and physical exam (limb ischemia). PCD is life threatening, the patient received therapy (catheter directed thrombolysis) and did well, well done Yale!
Sono Pearl: If locating the popliteal vein proves difficult, try applying added pressure with the linear probe. This should help first locate the popliteal artery due to its pulsatility, then ease up on the amount of pressure applied. The popliteal vein should be located just superficial to the artery (‘Pop on top"), and should appear in view as you let up pressure.