Post thrombotic skeletal scar tissue

Case contributed by Mr. Dennis Odhiambo Agolah

Presentation

Left lower limb swelling and pain in a fourty five year old female with previous history of left lower limb DVT management with anticoagulants fifteen years ago.

Patient Data

Age: 45 years
Gender: Female
Ultrasound

A gently undulating and hyper-reflective thick linear material is noted within the left common femoral vein with resultant intra-luminal compartmentalization and incomplete luminal coaptation on graded probe pressure application. 

The synaechal web of the skeletal scar tissue (pointed with arrows) extends crania-caudally within the left common femoral vein and is unobstructive. 

Attendant multiple left lower limb superficial subcutaneous venous varicosities (mostly arising from the mildly dilated left greater and the lesser saphenous veins) is noted and there is mild left leg subcutaneous tissue edema regionally along the variceal lines ipsilaterally.

Case Discussion

Often, the parallelization of the linear post thrombotic skeletal scar tissue is easily picked up sonographically during peripheral vascular studies and any history of previous DVT management normally strengthens/confirms unequivocally this diagnosis (as in this case). The skeletal synaechia however, when syndromic, may interfere with the venous valves' competency thus leading to varicosities and subcutaneous tissue edema.

Again, it is important to assess for features suggestive of new recurrence of deep or superficial venous thrombosis. In this particular presentation, the cause of the left lower limb swelling was syndromic attributed to post thrombotic skeletal scar tissue leading to the superficial varices and leg edema ipsilaterally.

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