RMH Case. A 41 y.o. male presents to ambulatory care with back pain. Initially seen by physio- however history wasn’t typical of MSK back pain so Emergency Doctor was asked to review. History revisited- 2/7 back pain and mild bilateral leg oedema. Past Medical History of unprovoked PE and DVT 20 years ago abroad, previously anticoagulated, now ceased. IVC filter in situ, and previous thrombophilia screen negative. ED POCUS AAA done by Emergency Doctor to exclude AAA, and look at IVC. Image 1. Aorta Trans View. Normal Aorta appearance, with distended looking IVC. No flow was seen in IVC and non-compressible. Image 2. Aorta Trans View at level of Iliac Arteries. Good flow through bilateral iliac arteries. Bilateral distended iliac veins with no obvious flow and non-compressible.  ED POCUS DVT done by Emergency Doctor Image 3. R CFV View (Common Femoral Vein)- non-compressible CFV at the level of the great saphenous vein junction. Proximal DVT was suspected and the patient was booked for a CT Venogram and referred to Vascular with suspected large burden proximal DVTs. A CT Venogram confirmed extensive venous thromboembolism from IVC just below IVC Filter to iliac veins and femoral veins bilaterally. A CTPA was booked which also showed bilateral segmental and subsegmental PEs. The patient underwent a catheter directed thrombolysis through popliteal approach the following day, followed by a thrombectomy from IVC to inguinal ligament bilaterally. They were transitioned to LMWH and discharged home after 5/7 with life-long Apixaban, and consented for IVC filter removal as an outpatient. Utility of POCUS In this case the strange, enlarged appearance of the IVC when performing a AAA POCUS Exam raised the suspicion for a proximal DVT. In practice, this can happen and can lead you to perform a different POCUS exam/ combine POCUS exams. The confirmation of a proximal limb DVT seen helped rule in proximal DVT as a cause for the presentation. Learning Points Please review the DVT POCUS Video https://youtu.be/ax0ttMUADQ0 to go through how to perform this exam. This article nicely explains the 3-compression technique and DVT thrombus appearance: https://www.tampaemergencymedicine.org/blog/dvtin123