Synechiae in superficial femoral and popliteal vein

Case contributed by Dr Ashesh Ishwarlal Ranchod

Presentation

The patient had a previous deep venous thrombosis 2 years prior and presents with acute calf pain. Doppler requested to exclude recurrent venous thrombosis.

Patient Data

Age: 50 years
Gender: Female

Venous doppler left lower limb

Ultrasound

Venous doppler assessment of the left lower limb demonstrated the presence of a thin fibrous membrane (synechia) within the distal superficial femoral vein with extension into the popliteal vein. There is well-identified venous flow on either side of the synechiae.

There was no recurrent deep or superficial venous thrombosis present.

Sonographer: Ms Nazia Jouley

Synechiae and dual venous flow

Annotated image

Annotated images of the synechiae and dual flow on either side of the fibrous band within the distal left superficial femoral vein and proximal left popliteal vein.

Case Discussion

This patient had prior deep venous thrombosis and underwent thrombolysis. There were no documented complications post diagnosis and treatment. She subsequently presented with acute calf pain after two years and was referred for a venous doppler assessment to exclude recurrent deep or superficial venous thrombosis.

Doppler assessment confirmed a residual, thin fibrous band/ membrane within the distal superficial femoral and proximal popliteal veins.

Recanalization of veins post-acute deep venous thrombosis involves a complex, multiphasic process of remodeling. A fibrous membrane may remain behind in the vein. This membrane is called a synechia (pleural - synechiae). These fibrous bands may easily be identified due to vascular flow on either side of the membrane within the vessel being interrogated as demonstrated above.

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