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Where There's Smoke, There's Fire: A Case Report of Turbulent Blood Flow in Lower Extremity Point-of-care Ultrasound

Mathew Nelson1, Dorothy Shi1, Miles Gordon1

  • 1North Shore University Hospital, Department of Emergency Medicine, Manhasset, New York.

Clinical Practice and Cases in Emergency Medicine
|February 9, 2021
PubMed

Insights

Turbulent blood flow on ultrasound in COVID-19 patients may signal increased risk for venous thromboembolism (VTE). This finding, observed in two cases, suggests a potential marker for early anticoagulation consideration in at-risk individuals.

Area of Science:

  • Vascular Medicine
  • Emergency Medicine
  • Infectious Diseases

Background:

  • Coronavirus disease 2019 (COVID-19) is associated with an elevated risk of venous thromboembolism (VTE).
  • Pathophysiological mechanisms include endothelial injury, inflammation, and reactive thrombocytosis, correlating with disease severity.
  • Predicting VTE risk in COVID-19 patients remains challenging despite the need for early identification and treatment.

Purpose of the Study:

  • To investigate the potential of novel ultrasonographic findings in identifying COVID-19 patients at increased risk for VTE.
  • To explore the clinical significance of turbulent venous blood flow as an early marker for clot development.

Main Methods:

  • Presentation of two case reports involving patients diagnosed with COVID-19.
  • Utilized point-of-care lower extremity ultrasound, specifically assessing for turbulent blood flow within the deep venous system.
  • Evaluated ultrasonographic findings in conjunction with clinical outcomes and subsequent VTE diagnosis.

Main Results:

  • Identified ultrasonographic findings of turbulent blood flow ('smoke') in the deep venous system of two COVID-19 patients.
  • These patients, initially without clear evidence of acute proximal deep venous thrombosis (DVT), were subsequently diagnosed with significant VTE.
  • Turbulent flow was observed in the absence of definitive DVT, suggesting it may precede or indicate a higher risk of clot formation.

Conclusions:

  • Point-of-care lower extremity ultrasound is a valuable tool for emergency physicians.
  • The novel finding of turbulent venous blood flow ('smoke') may serve as a predictive marker for VTE risk in COVID-19 patients.
  • This ultrasonographic sign could indicate the need for early consideration of anticoagulation therapy.
Abstract

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