Superficial venous thrombosis/thrombophlebitis

Keep your differential wide and keep using that ultrasound. Not everything you see on an athlete is a musculoskeletal problem.

This was an athlete that came to me for unresolved right groin pain despite rehab. He was from overseas with limited English-speaking ability and was known to the athletic training staff as one to “make up problems”.

This time his symptoms and complaints were overlooked by our staff a little bit… kind of a boy-who-cried-wolf scenario. In their defense, he had 3 MRIs for other ailments over the past few years that were negative.

Anyway, his exam was completely normal except for really tight hip flexors, as well as a weirdly cord-like tightness in the flexor-adductor region. Perfect time to pull out the ultrasound machine—and these videos are from that exam. The second video is a compression test for vascular studies such as when you’re looking for a DVT. Veins normally collapse.

Even though the ultrasound exam clearly showed what it was, I’d never written a vascular ultrasound procedure note before, so I ordered a formal ultrasound duplex study to be done at the hospital by a licensed sonographer and interpreted by a radiologist before referring him.