Two-point compression ultrasound for DVT

The most learnable test in ultrasound: a normal vein flattens completely when you press. A vein full of clot does not.

Live simulator — try itFull interactive lesson →

Where

1. Groin: the common femoral vein near the saphenofemoral junction. 2. Behind the knee: the popliteal vein. Use a linear probe in transverse.

How

From lateral to medial in the groin: Nerve, Artery, Vein (NAVeL). Press until the artery just starts to deform. If the vein disappears completely, there is no clot at that point. Step along and repeat.

Pitfalls

Pressing too gently — the commonest cause of a false positive.
Expecting clot to look grey: fresh clot can be anechoic. Trust compression, not appearance.

Real scans

Femoral vein DVT — Echogenic thrombus fills the femoral vein in the groin (arrow); it would not compress with probe pressure. — **Femoral vein DVT.** Echogenic thrombus fills the femoral vein in the groin (arrow); it would not compress with probe pressure. James Heilman, MD · CC BY-SA 4.0 · source

Normal compressible vein: internal jugular (clip). A normal internal jugular vein is completely flattened by light probe pressure, while the artery stays round. This is how a vein without clot behaves. Gillman L, Blaivas M, Lord J, Al-Kadi A, Kirkpatrick A · CC BY 2.0 · source

Popliteal vein thrombosis on compression (animated) — Compression ultrasound of the popliteal fossa: the thrombosed popliteal vein does not collapse when pressed. Small image (313 px). — **Popliteal vein thrombosis on compression (animated).** Compression ultrasound of the popliteal fossa: the thrombosed popliteal vein does not collapse when pressed. Small image (313 px). Ciernik M · CC BY-SA 4.0 · source

Learn this with your hands. Sonoduck gives you a 3D patient, a probe and a coach that tells you what to do. Free to start, no signup.

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FAQ

Is colour Doppler needed for DVT?

Compression is the primary test; Doppler is an adjunct.

Related guides

Linear, curvilinear or phased array?The three ultrasound probes explained — frequencies, footprints, image shapes and which to use for vessels, lungs, abdomen and heart — plus the probe marker convention.
The IVC on bedside ultrasoundHow to scan the inferior vena cava, what IVC size and respiratory collapse suggest about right atrial pressure, and the big caveats.
Knobology: the four knobs that matterHow to set ultrasound gain, depth, focus and frequency — with a live simulator so you can turn the knobs and see what happens.

Educational content for learners; follow local protocols and supervision. Simulated images are generated by Sonoduck’s physics model; real images are credited individually.