Lower Extremity Venous Doppler Report Template: Normal, DVT and Limited Studies

Lower extremity venous duplex report template

First establish whether the request is for suspected deep vein thrombosis (DVT), follow-up of known thrombosis, or venous reflux mapping. These are different examinations. A DVT report must identify the veins and segments examined, laterality, compressibility, Doppler findings where obtained, and any technical limitation. Never call an examination “negative” for the entire leg if only a proximal or otherwise limited protocol was performed.

Indication: [Symptoms, side, and relevant DVT history]
Comparison: [Date and result, if available]
Technique: [Right / left / bilateral] lower extremity venous duplex. Gray-scale compression and color and spectral Doppler were performed in the [specified segments]. [Calf veins / iliac veins / other segments] were [included / not included / not visualized]. [Technical limitation, if present.]

Findings:
Right: [Common femoral vein and saphenofemoral junction, profunda femoris origin, femoral vein by segment, popliteal vein, and calf veins according to protocol. State compressibility and thrombus extent. Describe flow and phasicity where sampled.]
Left: [Same review, or state that this side was not examined.]
Other findings: [Relevant incidental finding, if present.]

Impression:
1. [No DVT in the named segments examined / DVT with side, vein, segment, and extent.]
2. [Acute/recent, indeterminate, or chronic post-thrombotic change when supported; state limitation or comparison.]

The phrase “no DVT in the examined segments” is more accurate than “no DVT” when the study is incomplete or does not include the whole leg. Follow the examination’s local protocol and name it clearly.

What to document

• Indication and laterality: Include the symptomatic side and relevant history. Record comparison imaging when available.
• Protocol and coverage: Say whether the study is unilateral or bilateral and whether it is a comprehensive thigh-to-ankle, proximal, or other locally defined examination.
• Vein-by-vein findings: Identify the common femoral vein, saphenofemoral junction, proximal profunda femoris, femoral vein (proximal, mid, and distal), popliteal vein, and calf veins when included in the performed protocol.
• Thrombus description: Give side, vein, segment, extent, occlusive or nonocclusive status, and relevant Doppler flow. Describe compressibility and the sonographic features supporting the conclusion.
• Chronicity and comparison: Do not infer thrombus age from echogenicity alone. Use “chronic post-thrombotic change” for residual changes when supported, and compare with prior images if available. If the appearance cannot be confidently categorized, say so.
• Limitations: State which segments were not visualized or were inadequately assessed and why. Iliac veins and the IVC may be beyond the acoustic field of a routine leg examination.

The 2018 Society of Radiologists in Ultrasound (SRU) consensus recommends a comprehensive duplex protocol from thigh to ankle with Doppler at selected sites and favors “chronic post-thrombotic change” for persistent residual material, rather than language that may imply a new acute clot. The AIUM 2024 parameter describes evaluation from the inguinal ligament to the ankle when feasible. If a limited protocol is performed, document its coverage and follow the institution’s pathway for any additional evaluation.

Fictional worked examples

The cases below are invented for teaching. They are not patient reports and should be adapted to the examination actually performed.

Negative bilateral whole-leg study

Indication: Bilateral lower leg swelling, greater on the right.
Comparison: None available.
Technique: Bilateral lower extremity venous duplex. Gray-scale compression, color Doppler, and spectral Doppler were performed from the common femoral veins through the calf veins.

Findings:
The common femoral veins, saphenofemoral junctions, profunda femoris origins, femoral veins, popliteal veins, and visualized paired calf veins are patent and fully compressible bilaterally. Color filling is present. Spectral Doppler demonstrates respiratory phasicity in the common femoral veins and popliteal veins.

Impression:
No deep venous thrombosis in either lower extremity in the segments examined.

Acute nonocclusive thrombosis

Indication: New left calf pain and swelling.
Comparison: None available.
Technique: Left lower extremity venous duplex from the common femoral vein through the calf veins using compression, color Doppler, and spectral Doppler.

Findings:
The common femoral vein, saphenofemoral junction, profunda femoris origin, proximal and mid femoral vein, and visualized calf veins are patent and compressible. A short segment of the distal femoral vein contains nonocclusive intraluminal thrombus with incomplete compressibility and residual color flow. The popliteal vein is patent and compressible.

Impression:
Short-segment nonocclusive deep venous thrombosis of the distal left femoral vein.

Technically limited examination

If a segment cannot be evaluated, describe it directly. For example: “The left calf veins are not adequately visualized because of edema and pain. No DVT is identified in the compressible common femoral, femoral, or popliteal veins.” The impression should preserve the same boundary: “No DVT in the visualized proximal left lower extremity; calf veins are incompletely assessed.”

Residual post-thrombotic change

Indication: Persistent left leg swelling; prior left popliteal DVT.
Comparison: Left lower extremity venous duplex dated [date].
Technique: Left lower extremity venous duplex using compression, color Doppler, and spectral Doppler from the common femoral vein through the calf veins.

Findings:
The common femoral and femoral veins are patent and compressible. At the popliteal vein, there is eccentric wall-adherent echogenic material with partial compressibility and recanalized flow, similar to the prior examination. The calf veins are patent and compressible.

Impression:
Stable chronic post-thrombotic change in the left popliteal vein. No new DVT identified.

Only use the final example’s chronic wording when the appearance and comparison support it. Otherwise, describe the morphology and state that chronicity is indeterminate.

DVT study is not reflux mapping

A DVT examination addresses venous thrombosis using the local compression and Doppler protocol. Venous insufficiency mapping asks a different question and may require positioning and provocation to assess reflux in named superficial and deep segments. Do not add “no venous insufficiency” to a DVT report when a reflux protocol was not performed.

A venous DVT study does not assess arterial stenosis or limb arterial perfusion; those questions require an arterial ultrasound protocol.

Avoid “superficial femoral vein” for the femoral vein; it is part of the deep venous system. Do not describe a limited scan as a complete negative whole-leg study. Do not use a fixed sentence to date thrombus when ultrasound appearance and clinical history are discordant.

For a concise first-call worksheet and related reporting resources, see the radiology first-call starter pack.

References

1. American Institute of Ultrasound in Medicine. Practice Parameter for the Performance of a Peripheral Venous Ultrasound Examination, 2024 Revision. AIUM parameter (opens in a new tab)
2. Needleman L, et al. Ultrasound for Lower Extremity Deep Venous Thrombosis: Multidisciplinary Recommendations From the Society of Radiologists in Ultrasound Consensus Conference. Circulation. 2018;137:1505–1515. doi:10.1161/CIRCULATIONAHA.117.030687 (opens in a new tab) This educational framework does not establish the adequacy of a study or exclude disease outside its documented coverage. Adapt it to the images, local protocol, clinical question, and applicable follow-up pathway.