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UVMFLOWNET  February 2014

UVMFLOWNET February 2014

Subject:

Re: Terminology

From:

Nathalie Garbani <[log in to unmask]>

Reply-To:

UVM Flownet <[log in to unmask]>

Date:

Tue, 4 Feb 2014 19:08:43 -0500

Content-Type:

text/plain

Parts/Attachments:

Parts/Attachments

text/plain (208 lines)

as FYI, "rouleaux" in French does not only refer to a roll of coins,  
but to  everything that has a circular kind of motion or pattern, like  
the waves rolling before the break on the beach 9these are called  
rouleaux as well).
Taken with that definition, helps understand what is visualized in  
these veins, and which to me is more similar to the pattern seen at  
the carotid bulb where the cells move in many different directions and  
appear to roll before or at the same time they also move forward  
(taking into consideration that the speed of flow in a vein is much  
slower than in an artery, which gives that "sluggish" appearance of  
the flow)
as Dr. Schneider mentioned, it would interesting to explore what  
causes this phenomenon as, as some other have brought forth I have not  
really seen in more in patients with hypercoagulability (so I do not  
think it is related to increase in thrombosis)

Nathalie
Quoting Carolyn Semrow <[log in to unmask]>:

> After reading the article in JUV I realized that SEC is really  what  
> in venous imging we refer to as moving luminal echoes.
> The observation of "moving luminal echoes" has been  reported since  
> the initial studies were conducted to determine the feasibility of  
> venous imaging as a replacement for contrast venography:   
> develop reproducible method to evaluate the entire venous system  
> from ankle to groin,  determine image characteristics for normal &  
> disease veins and validate results.   The initial work -in-progress  
> report on the technique & characteristic was presented to the AIUM  
> in Sept 1984 and published in Bruit 1985 & JVT 1987. The technique  
> was developed imaging the LE of 20 healthy young volunteers who had  
> no history or physical evidence of venous disease as well as  
> negative Venous Doppler & PPG Refilling Time  
> Plethysmography. Volunteers consented to ACV within 24 hrs  
> of ultrasound exam. Five patients with clinical signs & symptoms of  
> acute DVT or postphlebitic syndrome had ultrasonic venographic  
> examination followed by ACV within 24 hrs  to determine
>  the diagnostic capabilities and develop the ultrasonic diagnostic  
> criteria for each disease. Once the criteria was  
> established ultrasonic venography was preformed on 15 consecutive  
> DVT & CVD patients referred to the PVL for venous evaluation. Every  
> patient had ACV within 24 hr after the ultrasound. This research was  
> conducted using a 7.5MHz linear array transducer & B-Mode  
> imager. This was early in vascular ultrasound  when heavy sector  
> scanner transducers were the only vascular option. The early  
> acceptance of venous imaging lead to the entry of duplex linear  
> array system in 1986. 
>  Moving luminal echoes were seen as often in normal as in both acute  
> & chronic venous disease patient. They were used as part of the  
> diagnostic criteria, basically a visual Doppler,  phasic movement,  
> flow augmentation with distal augmentation & retrograde flow through  
> incompetent valves with proximal augmentation. Moving luminal echoes  
> assisted in the identification of recently formed anechoic  
> thrombus, extent of propagation as they could be seen flowing over  
> or around the floating anechoic thrombus tail or when there was a  
> total obstruction moving luminal echoes could be seen moving into  
> perforator branches or communicating veins distal to the obstruction  
> flowing around the obstruction then re-entering the deep system  
> above the obstruction all without need to augment flow or mashing  
> down on the leg every centimeter or so . They were also useful in  
> assessing valve function & identifying perforator function  
> & category of incompetence (outflow
>  perforator around obstruction or inflow perforator proximal to  
> obstruction returning flow to deep veins) in the postphlebitic  
> limb.      
> Most likely the reason for the common occurrence of moving luminal  
> echoes in our patient population is due to the imaging technique we  
> use. In our protocol the evaluation is performed with the patient  
> sitting on an exam table or elevated chair with legs dangling, the  
> foot of the limb to be examine resting on the examiners knee. By the  
> time we complete the patient ultrasound & venous system education  
> the patient is comfortable with relaxed leg muscles  allowing venous  
> pooling to occur. The increased blood volume due to pooling  
> increases normal red cell aggregation that occurs in the low flow  
> state.  Other members of our research team:  Sigel B, Machi J, etal  
> Radiology 1983. ( full reference in Dec 2013 JVU article) confirmed  
> this hypothesis. 
> Over past 30 + yrs of venous imaging with all the advancement in  
> equipment & resolution we haven't noticed presence of moving luminal  
> echoes trending toward any specific condition or disease  
> process. The only notable difference is the anxious or impatient  
> patient who is constantly moving and refuses to relax. However if I  
> can get them to fall asleep in the dark, warm room by turning on the  
> Doppler not only is the exam easier but the moving luminal echoes  
> appear as well. 
> Hope this helps clear up the mystery of moving luminal echoes.
> However, after reading the article in Dec 2013 JVU I was wondering  
> how flow is being measured to report that it is slower or faster in  
> x place compare to y. 
>      
>
> Carolyn M Semrow, RVS
>
>
> "A master, in the art of living, draws no sharp distinction
> between his work and his play, his labor and his leisure,
> his mind and his body, his education and his recreation.
> He hardly knows which is which. He simply pursues his
> vision of excellence through whatever he is doing and leaves
> others to determine if he is working or playing. To himself
> he always seems to be doing both."
> Francois-René Chateaubriand  (1768-1848)
>
>
>
>
>
> The HTML graphics in this message
>
>
>> ________________________________
>> From: S Ewing <[log in to unmask]>
>> To: [log in to unmask]
>> Sent: Tuesday, February 4, 2014 10:05 AM
>> Subject: Re: Terminology
>>
>>
>>
>> That's it !I knew I read it somewhere and couldn't remember where .  
>>  Thanks so much .
>> On Feb 4, 2014 8:25 AM, "Simons, Donald" <[log in to unmask]> wrote:
>>
>> There was recently an article pertaining to this in the December  
>> 2013 issue of the SVU?s Journal for Vascular Ultrasound. The  
>> article title is:  Description of a Phenomenon Resembling  
>> Spontaneous Echocardiographic Contrast in the Venous System.  There  
>> is a CME quiz for it in this issue if anyone is interested.
>>>  
>>> Don
>>>  
>>> From:UVM Flownet [mailto:[log in to unmask]] On Behalf Of   
>>> Audrey Fleming
>>> Sent: Tuesday, February 04, 2014 6:36 AM
>>> To: [log in to unmask]
>>> Subject: Re: Terminology
>>>  
>>> And with the new equipment (compared to the olden days of yore) we  
>>>  can see much more detail. This has been around since real-time   
>>> scanning was first performed. It's just that we have the   
>>> resolution to see it more often now.
>>>
>>>
>>>  
>>> From:Kris10 G <[log in to unmask]>
>>> To: [log in to unmask]
>>> Sent: Tuesday, February 4, 2014 2:47 AM
>>> Subject: Re: Terminology
>>>  
>>> This is usually caused by an increase in protein.  It can be  
>>> caused by cancer, infection, and I believe diabetes, it is not  
>>> always an indication of venous problems specifically. People can  
>>> present with rouleaux flow and not have clot/disease, they just  
>>> have slow, sluggish flow.
>>>  
>>>  
>>> On Tuesday, February 4, 2014 1:39 AM, Bill Johnson   
>>> <[log in to unmask]> wrote:
>>> As in a "roll of the dice?"
>>>  
>>> On Tue, Feb 4, 2014 at 1:37 AM, Bill Johnson   
>>> <[log in to unmask]> wrote:
>>> I believe Travis is correct.  The first time I saw it I was sure I  
>>> was seeing clots form before my eyes.  Not so sure now, but when  
>>> blood cells stack up on one another, I cannot think anything good  
>>> comes from that.  Especially if they are going downstream into a  
>>> narrowed vessel. And flowing against an endothelium that is doing  
>>> all it can to ward off inflammation? How can that be helpful?.  It  
>>> is not about the "smoke." It is, to my mind, but more about the  
>>> "mirrors". 
>>>  
>>> There are many more folks on this list that can educate us about  
>>> this "phenomenon" than I.  I hope they chime in.
>>>  
>>> On Tue, Feb 4, 2014 at 12:09 AM, Travis Bille   
>>> <[log in to unmask]> wrote:
>>> That would be Rouleaux formation, I believe
>>>
>>>
>>> On Monday, February 3, 2014, S Ewing <[log in to unmask]> wrote:
>>> What it the term used to describe the highly viscous  appearing  
>>> venous  flow ? In echo it was called smoke.  Thanks in advance.   
>>> Sharen Ewing ,BS RVT RDCS.
>>> To unsubscribe or search other topics on UVM Flownet link to:   
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>>>  
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>>> To unsubscribe or search other topics on UVM Flownet link to:   
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> To unsubscribe or search other topics on UVM Flownet link to:   
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> To unsubscribe or search other topics on UVM Flownet link to:   
> http://list.uvm.edu/archives/uvmflownet.html
>>
>>    
>
> To unsubscribe or search other topics on UVM Flownet link to:
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