An elderly gentleman with known lung cancer who was on warfarin presented with rapid onset of a painful blue leg. He had a past history of peripheral arterial disease and distal pulses could not be felt on either side.
Grey scale imaging revealed an echogenic mass which prevented normal venous compression in the right common femoral vein. The mass was seen to extend proximally into the external iliac vein with absence of the normal color Doppler flow. The IVC contained an echogenic mass which extended proximally to just below the liver.
Examination of the left sided venous system also revealed echogenic clot in the external iliac to femoral veins.
The veins distal to the femoral veins were not examined.
Massive venous thrombosis extending from the IVC bilaterally into iliac and femoral veins.