THE USE OF DEEP INSPIRATION PRECEDING THE VALSALVA MANEUVER AND RAPIDEXPIRATION IN COLOR DOPPLER IMAGING OF THE LOWER-EXTREMITY VEINS

Deep inspiration preceding Valsalva maneuver and rapid expiration imme diately following it (DIVE) enhance venous blood flow on color Doppler flow imaging (CDI). The effect of DIVE was assessed in 115 consecutiv e lower extremity examinations. Of these, 95 or 115 (83%) had negative CDI sonograms, and 20 of 115 (17%) had partially (six of 115) or comp letely (14 of 115) occluding deep vein thrombosis. DIVE enhanced venou s blood flow in 68% of the negative cases, resulting in transient veno us distention, and/or more complete color filling, and/or greater spec tral flow velocities. The 14 cases with completely occluding thrombi s howed no response to DIVE. Six cases with partially occluding thrombi showed moderate to mild response to DIVE, with improved color delineat ion of the residual patent lumen around the thrombus. The authors conc lude that DIVE facilitates deep venous CDI, especially when compressio n cannot be used to augment venous flow.