Image 1: Clot visualized at the saphenofemoral junction.
Image 2: Normal saphenofemoral junction.
A patient presents with unilateral leg pain and swelling.
The starting point of every POCUS Deep Vein Thrombosis (DVT) study should be the saphenofemoral junction. Image 1 shows clot (hyperechoic material) in the saphenofemoral junction. Clots like to get caught at branch points, which is why a POCUS DVT that starts distal to the saphenofemoral junction is an indeterminate study, and a very dangerous potential false negative. Image 2 is a negative saphenofemoral junction, with the provider compressing with enough pressure to fully collapse the walls. POCUS DVT is compression ultrasonography, the walls must fully collapse to be able to say no clot.
POCUS Pearl: To identify the saphenofemoral junction as you start your POCUS DVT study, try to resist the urge to compress. Just find it first, as pressure on the vein can collapse the walls of the junction making it more difficult to identify.