Spectral Doppler analysis of the lower limbs demonstrates unmistakable bilateral pulsatile venous flow pattern more pronounced at the bilateral common femoral veins. Short axes and longitudinal planes along the common femoral veins shows strongly coapting and opening bicuspid valves with significant antegrade components and left sided small persistent atrial wave signifying elevating right ventricular and ipsilateral right atrial pressures respectively, the waveforms of which have been described by some authors to resemble the ''square root'' sign of the diastolic component and an exaggerated ''Y'' descent of the retrograde component indicative of severe right ventricular (RV) diastolic dysfunction^1-3.

No evidence of deep or superficial thrombophlebitis save for the bilateral subcutaneous lymphedema seen. The main portal vein appeared normal with no overt Doppler flow changes. mild engorgement of the hepatic veins was appreciated.