The patient presented with unilateral lower limb swelling after a long trip. There was pitting edema at the level of the ankle but no injury was reported. The concern from the referring doctor was that there may be a possible deep vein thrombosis

Using a high linear frequency probe a deep vein thrombosis was comfortably excluded. Of significance was a large caliber greater saphenous vein which distended under valsalva and prolonged reversal of flow could be demonstrated on spectral Doppler.

The short saphenous vein also demonstrated distension in the erect position with reversal of flow as demonstrated on colour doppler. In this case the red colour represents normal flow to towards the heart. When the patient is asked to increase the intra-abdominal pressure the flow reverses and changes to blue.

Multiple incompetent perpetrators were noted along the medial aspect of the calf.

We could assist the referring doctor by:

– excluding a deep vein thrombosis

– by confirming a sapheno-femoral junction and sapheno-popliteal junction incompetence with multiple incompetent perforators.

Other warning signs for venous incompetence include hyperpigmentation of the skin, varicose veins. Venous ulcers can also occur.