The Ultrasound of Intravenous Drug Abuse in the Groin - Vascular and Non-vascular Complications: A Pictorial Review

Abstract

Intravenous drug abuse is a common social and medical problem. Incidence is estimated at 9·9 per 100 000 for England. In the ultrasound department, a common referral is for ‘IVDA QDVT’ (intravenous drug abuser, query deep vein thrombosis). Deep vein thrombosis (DVT) is a common complication of intravenous injection of drugs via the groin, but ultrasonically can present with a variety of different acute and chronic features, including complications. The groin should also be examined for other vascular and non-vascular complications. Non-vascular complications include cellulitis, sinus track formation, abscess and lymphadenitis. Vascular complications include arterial occlusion, arteriovenous fistula, pseudo-aneurysm, acute and chronic DVT, venous stenosis and complex collateral formation. The sonographer should also be aware of distant complications including endocarditis, septic pulmonary emboli and retroperitoneal extension of groin abscess. This is an increasing diagnostic problem. The sonographer should be aware of the range of pathologies both locally and systemically and be prepared to examine the veins, arteries and soft tissues, extending the examination above the groin and using imaging modalities if findings are atypical. If necessary, the radiologist should be involved at an early stage.