POCUS and critical care echo

Two-region compression ultrasound for DVT

Reviewed Nov 2026·1 references
New· views rounded down, updated weekly

Compress the common femoral vein (and saphenofemoral junction) and the popliteal vein with a linear probe. A non-compressible vein means DVT. A negative 2-point scan in a high-probability patient needs repeat at 1 week or a whole-leg scan.

At the bedside

Timed steps
  1. 1

    Leg

    Position

    Frog-leg, slight reverse Trendelenburg; linear probe, transverse.

  2. 2

    Femoral

    Region 1

    Common femoral vein from inguinal ligament through saphenofemoral junction to femoral bifurcation; compress every 1-2 cm.

  3. 3

    Popliteal

    Region 2

    Popliteal fossa down to the trifurcation.

  4. 4

    Compressibility

    Interpret

    Full compression = no DVT at that site; incomplete compression = DVT (echogenic thrombus may not be visible).

  5. 5

    High probability

    Negative scan

    Repeat in 5-7 days or whole-leg Doppler; combine with D-dimer.

Red flag · call your senior now
Free-floating thrombus: avoid vigorous compression.
Pitfall
Mistaking the artery for the vein (artery is round and pulsatile, does not compress).
Pearl
Proximal DVT in a patient with shock and RV dilatation strongly supports PE.

References

  1. 1

    Bernardi E, Camporese G, Büller HR, et al. Serial 2-point ultrasonography plus D-dimer vs whole-leg color-coded Doppler ultrasonography for diagnosing suspected symptomatic deep vein thrombosis. JAMA. 2008;300(14):1653-1659

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