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Updated: Mar 1, 2026

Point-Of-Care Ultrasound Screening for Proximal Lower Extremity Deep Venous Thrombosis
Published on: February 10, 2023
Diagnostic Considerations of Venous Thromboembolic Disease
Sulaiman Alhassan1, Jennifer Leap, Anand Popuri
1Division of Pulmonary and Critical Care Medicine (Drs Alhassan, Popuri, Yadam, Singh, and Balaan) and Department of Medicine (Dr Leap), Allegheny General Hospital, Pittsburgh, Pennsylvania.
Abstract:
Venous thromboembolism (VTE) includes deep venous thrombosis (DVT) and pulmonary embolism (PE). The clinical presentation of VTE is nonspecific and requires confirmatory testing. The most common diagnostic tool for DVT is duplex ultrasonography since it is a noninvasive test with high accuracy. Contrast venography is considered the gold standard modality to diagnose DVT, but it is an invasive test. Magnetic resonance venography and computed tomography venography are alternative diagnostic methods for DVT, which can be helpful in certain circumstances. Pulmonary embolism is commonly diagnosed by computed tomography pulmonary angiography. Ventilation perfusion scanning is an alternative imaging to diagnose PE in patients who cannot receive intravenous contrast. Pulmonary angiography is still the gold standard in the diagnosis of PE and is usually needed in specific conditions. D-dimer assay can be utilized in ruling VTE out in low-risk patients. Estimating the pretest clinical probability for having VTE is the key step in guiding the clinicians and nurses to the appropriate diagnostic method for patients with suspected DVT or PE.
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Jugular Venous Pressure (JVP) Measurement
Position the patient at a thirty- to forty-five-degree angle or in a semi-fowler's position. Look for the highest point of pulsation in the internal jugular vein and measure the vertical distance to the angle of Loius or sternal angle. A normal JVP is 3-4 cm above...

