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Abdominal inferior vena cava
1%
1/78
Great saphenous veins
6%
5/78
Proximal femoral veins
81%
63/78
Posterior tibial veins
10%
8/78
Basilic veins
0%
0/78
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Venous ultrasound in this patient suffering from a pulmonary embolism would most likely reveal a deep venous thrombosis in the proximal femoral veins. The most common source of symptomatic pulmonary emboli is the proximal deep leg veins. The majority of pulmonary emboli originate from a deep venous thrombosis (DVT) in the lower extremities. The presence or absence of the Homan's sign is unreliable in determining the presence of a DVT due to its relatively low sensitivity and specificity. In a clinical scenario indicative of a possible pulmonary embolism, if a spiral CT scan returns an inconclusive result, then venous ultrasound of the lower extremities should be performed to detect a DVT that may have been responsible for the thromboembolus. Serial venous ultrasounds have a high diagnostic specificity. Incorrect Answers: Answer 1: The IVC is not as common of a source for pulmonary emboli as the proximal deep leg veins. Answer 2: The great saphenous vein is a superficial vein of the lower extremity; pulmoary emboli usually do not originate from superficial veins. Answer 4: The posterior tibial vein is a deep leg vein of the distal lower extremity; symptomatic pulmonary emboli more commonly originate from the proximal deep venous system. Answer 5: The basilic vein is a large superficial vein of the upper extremity; it is typically not a source of pulmonary emboli.
4.8
(5)
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