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Venous insufficiency is a cause of substantial morbidity and medical expenditures. Diagnostic US evaluation of venous insufficiency requires a thorough understanding of the venous anatomy, including the deep, superficial, and perforator veins. The highly variable venous anatomy requires that operators use sound judgment to expand on protocol images and thus avoid missing important sources of reflux. The US examination requires specific patient positioning and use of provocative maneuvers. A basic understanding of the pathophysiology of venous insufficiency and the various treatment methods helps to identify key observations so that ineffective treatment methods are not pursued. The examination reports should have greater detail than those for the more common lower extremity deep venous thrombosis evaluation, requiring numeric and narrative descriptions of deep and superficial venous patency, reflux, diameter, and pathways. Potential pitfalls include not recognizing or detecting deep venous reflux, misidentifying common femoral vein reflux as deep venous reflux when the reflux is isolated or related to saphenofemoral insufficiency, not recognizing anterior accessory great saphenous vein (AAGSV) involvement in saphenofemoral insufficiency, not recognizing or reporting great saphenous vein or AAGSV superficialization, not suspecting central venous obstruction, and not realizing when provocative maneuvers were ineffective. With knowledge of the lower extremity venous anatomy, venous insufficiency pathophysiology, basic treatment strategies, protocol best practices, patterns of observation, and diagnostic pitfalls, those who interpret venous insufficiency US studies can perform examinations and deliver reports that help patients receive appropriate treatment.

Cross-sectional imaging has become a critical aspect in the evaluation of arterial injuries. In particular, angiography using computed tomography (CT) is the imaging of choice. A variety of techniques and options are available when evaluating for arterial injuries. Techniques involve contrast bolus, various phases of contrast enhancement, multiplanar reconstruction, volume rendering, and maximum intensity projection. After the images are rendered, a variety of features may be seen that diagnose the injury. This article provides a general overview of the techniques, important findings, and pitfalls in cross sectional imaging of arterial imaging, particularly in relation to computed tomography. In addition, the future directions of computed tomography, including a few techniques in the process of development, is also discussed.