I had an ultrasound done and was told I have deep vein reflux, but when I went to Mayo they found nothing other than a small superficial vein. I have leg pain in my calves, shins and upper legs. There is no swelling, but there is mild leg discoloration. Is it common for an interventional radiologist and a vascular doctor to see two different things in an ultrasound? Any suggestions as to what my condition may be?
Who did the exams? Was it a doctor or ultrasound tech? What matters most is their experience in this area. Some ultrasound techs have limited experience with looking at the superficial venous system, but so do some surgeons. The time of day could make a difference on what is visualized. In some patients, reflux is most apparent at the end of the day. Your leg complaints may have nothing to do with your veins. A good musculoskeletal exam can help sort this out.
Published on Jul 11, 2012
Ultrasound interpretation is very subjective and depends largely on the handler's level of expertise. For example, reflux is most reliably detected when the patient is standing, which is often not done properly. Phlebologists are generally more knowledgeable when it comes to vein disease.
Published on Jul 11, 2012
I would suppose it's not uncommon, especially since the IR is trained to read all imaging; that is, unless there is a misunderstanding on using the term 'deep'. Reflux in veins is not hard to find if present, and the tech that does the ultrasound would know it. Personally, I would have more confidence in the IR, especially since that is their focus: procedures using imaging. It might not be a bad idea to get a second opinion from another IR, not a vascular doctor.
Published on Jul 11, 2012
Ultrasound evaluation for venous insufficiency is variable and it would not be unusual for 2 different centers to note different findings. First of all, the technologist is the most important part of the testing. They need to be experienced in insufficiency investigations and follow a standard protocol in terms of which veins are investigated. The deep vein system includes the common femoral, femoral, popliteal and tibial veins, while the superficial venous system includes the great saphenous, anterior saphenous, posterior accessory, small saphenous and intersaphenous veins and also connecting or perforator veins. Other considerations are the length of the incompetent vein or segment of veins and the degree of insufficiency, which can be stratified based on the number of seconds the valves can be pushed open toward the feet (abnormal) with the valsalva maneuver (bearing down). Get copies of your reports and compare them to each other. Look to the veins and other factors listed above. Another opinion may be the best option if you are still lost.
Published on Jul 11, 2012
It is not uncommon for two medical professionals to see different things in an ultrasound. The Doppler ultrasound test may give different results in experienced hands and even by the same ultrasound technician on different days (about 5-10% of the time). The results of a Doppler ultrasound test are effected by the time of day, hydration status and recent support stocking use. The finding of a different result is especially common when they are slightly subjective, such as the presence of reflux. In inexperienced hands, the difference of results is even greater. Unfortunately, with the information I am given I don't think I could guess what the condition is.
Published on Jul 11, 2012
This presents a real dilemma. If possible, have each doctor share their studies with each other.
Published on Jul 11, 2012
First, it is possible to have different reports if the studies were done by the technologists without direct supervision of the physician who will read the report. On the other hand, it is not unusual to see some differences in reflux or degree of reflux on different days on the same patient. Your best option is to find a vein specialist (Phlebologist) who does the ultrasounds himself (not done by a technologist) and who will be more in tune with your particular symptoms and history. The vein specialist will be able to determine if any of the abnormalities found in your legs have a correlation with your symptoms as well. At the same time, he can delineate a more accurate plan of action on how to help you.
Published on Jul 11, 2012
It is common for veins to have different diameters on different days. Also, veins may reflux on one day and not another. Different factors can be involved including changing hormones, fluid status, caffeine intake, temperature, how long you been standing on your legs, et cetera. Therefore, the physicians may have both seen different things and both be right.
Published on Jul 11, 2012
It is possible that two specialists can see two different things in an ultrasound. I have seen and helped patients that other institutions have said there are no problems/nothing can be done.
Published on Jul 11, 2012
Ultrasounds can be interpreted differently by various doctors and specialists. Usually, however, major findings are the same but subtle differences can be viewed in another way. It is also important that the physician examine the patient regardless of the ultrasound or X-ray findings. There is no way of making a diagnosis based on what you've said. I would recommend following up with a vascular surgeon rather than a radiologist.
Published on Jul 11, 2012