Introduction: Post-thrombotic syndrome (PTS) is a common and debilitating complication of lower limb deep vein thrombosis (DVT) that has the potential to threaten the affected limb, whilst significantly reducing quality of life. Given that it develops in 20-50% of instances following proximal DVT, it is important to identify risks and signs of PTS as they arise. This relies on high quality ultrasound (US) that assesses and documents chronic DVT changes. This presentation provides insight on the classic sonographic appearances of chronic changes following DVT. It discusses the significance of identifying and documenting chronic change in relation to patient follow-up and therapy.
Method: Case studies will be used to illustrate the classic features of chronic change and the impact of leg DVT US on patient management. The presentation will also be supported by local quality audit data that outlines common risk areas in the performance and documentation of leg DVT US.
Results: High quality US that accurately detects and documents chronic changes in leg DVT examinations ensure that patients are adequately diagnosed and treated in the short-term, as well as in the work-up of PTS.
Conclusion: Chronic post-thrombotic changes play a crucial role in the management of DVT, and their proper identification on ultrasound is essential for guiding treatment and follow-up care.
Take home message: Sonographers should expand their focus beyond just acute DVT and be cognisant of chronic changes. They are also encouraged to effectively communicate these findings by constructing a detailed worksheet that describes and illustrates chronic DVT changes.

Fibromuscular dysplasia is a clinically significant, nonatherosclerotic arterial disease which has been reported in most arterial beds common to Duplex Ultrasound imaging. Despite this, the disease can be understood by sonographers which leads to misdiagnosis or misinformed disease description.
This presentation will detail the disease features identified on ultrasound, including velocity changes, flow derangement, vessel tortuosity and beading as well as an overview of optimal acoustic windows and patient positioning. Additionally, current literature recommendations for disease reporting and an explanation of why using ostial atherosclerotic velocity grading criteria to indicate the significance of fibromuscular dysplasia is inappropriate will be outlined.
The understanding of fibromuscular dysplasia ultrasound characteristics has changed over time. Addressing scan methodology and reporting to correctly inform the referring physician of the presence of this disease will improve the identification and treatment of this important subset of often symptomatic patients.

Pelvic congestion syndrome (female pelvic venous congestion) is a condition where varicose veins form in the pelvis, commonly due to left ovarian vein reflux, causing chronic pelvic pain. This presentation will cover:
• Clinical features and definitions
• Sonographic features
• Treatment options

Introduction: Arteriovenous fistulas (AVFs) are vital for haemodialysis, but about 25% fail to mature or experience early failure. Ultrasound is crucial for AVF management, with volume flow (Qa) serving as a key predictor of maturation. Accurate Qa measurements depend on precise brachial artery (BA) diameter assessments, as errors can cause significant discrepancies. Write-zoom, a sonographic feature that enhances spatial resolution by increasing pixel density, may improve measurement accuracy. This study investigates the effect of write-zoom on Qa measurements in AVFs.
Method: Thirty participants undergoing ultrasound surveillance of upper limb AVFs were included. Three diameter and three Qa measurements were obtained for each participant, with and without write-zoom. Statistical analysis compared the two techniques.
Results: Measurements using write-zoom (diameter: 6.0 ± 1.4 mm, Qa: 1318 ± 643 cc/min) differed significantly from those without write-zoom (diameter: 6.3 ± 1.3 mm, Qa: 1418 ± 744 cc/min). High correlations were observed between methods for diameter (R² = 0.9856, p < 0.0001) and Qa (R² = 0.9739, p < 0.0001). Reliability was higher with write-zoom for diameter (ICC₍₃₋₁₎ = 0.891) and Qa (ICC₍₃₋₁₎ = 0.934) compared to without write-zoom (ICC₍₃₋₁₎ = 0.871 and 0.846 respectively).
Conclusion: Write-zoom improves the reliability of Qa and diameter measurements, reducing the likelihood of overestimation. Incorporating write-zoom into ultrasound protocols could enhance early detection of at-risk AVFs and support timely interventions.
Take home message: Qa measurements may be overestimated if write-zoom is not used.

Introduction: Coeliac axis compression syndrome (CACS) and superior mesenteric artery syndrome (SMAS) are two types of vascular compression syndrome that can lead to chronic abdominal pain. Due to the rarity of these conditions, these syndromes are often overlooked during routine abdomen ultrasound scan or misdiagnosed as other medical conditions.
Methods: For this presentation there is explanation of the anatomy and etiology of median arcuate ligament in relation to CACS and the anatomical cause of SMAS.
The ultrasound methods of the diagnosis of CACS and SMAS will be presented, and the ultrasound diagnosis criteria for each syndrome will be discussed. Following that there will be presentations of several clinical case studies of each syndrome.
Results: All the clinical cases presented with recurrent abdomen pain, with previous ultrasound unable to identify the cause of the pain. With the initial ultrasound finding of CACS and SMAS, all patients underwent further examinations with other imaging modalities, which confirmed the findings.
Conclusion: Vascular compression disorder such as CACS and SMAS can cause recurrent abdomen pain. Further assessment of the coeliac artery and the superior mesenteric artery in addition to the routine abdomen ultrasound may help to identify the cause of the patient’s condition.
Take Home Message: CACS and SMAS are rare conditions that often overlooked in routine abdomen scan. With additional training and knowledge, combined with the patient’s clinical history, sonographers will be able to improve detection rate of these two syndromes.