Imaging Evaluation of the Inferior Vena Cava

Abstract

The inferior vena cava (IVC) is an essential but often overlooked structure at abdominal imaging. It is associated with a wide variety of congenital and pathologic processes and can be a source of vital information for referring clinicians. Initial evaluation of the IVC is most likely to occur at computed tomography performed for another indication. Many routine abdominal imaging protocols may result in suboptimal evaluation of the IVC; however, techniques to assist in specific evaluation of the IVC can be used. In this article, the authors review the spectrum of IVC variants and pathologic processes and the relevant findings from magnetic resonance imaging, angiography, sonography, and positron emission tomography. Embryologic development of the IVC and examples of congenital IVC variants, such as absence, duplication, left-sided location, azygous or hemiazygous continuation, and web formation, are described. The authors detail IVC involvement in Wilms tumor, leiomyosarcoma, adrenal cortical carcinoma, testicular carcinoma, hepatocellular carcinoma, renal cell carcinoma, and other neoplasms, as well as postsurgical, traumatic, and infectious entities (including filter malposition, mesocaval shunt, and septic thrombophlebitis). The implications of these entities for patient treatment and instances in which specific details should be included in the dictated radiology report are highlighted. Furthermore, the common pitfalls of IVC imaging are discussed. The information provided in this review will allow radiologists to detect and accurately characterize IVC abnormalities to guide clinical decision making and improve patient care.

Radiographic and computed tomographic features of caval foramen hernias of the liver in 7 dogs: mimicking lung nodules

“…Even though there have been no references to the clinical importance of CVC compression in dogs, various associated diseases have been reported in human medicine [7, 15]. For example, Budd-Chiari-like syndrome refers to hepatic venous outflow obstruction, resulting in portal hypertension and peritoneal effusion [13].…”

Ruptured inferior vena cava aneurysm in the setting of mural vascular malformation: A case report

“…In the present case, US showed the aneurysm features and provided a good visualization of surrounding tissues. Color Doppler US allows real‐time visualization of the blood flow within an aneurysm and branches, and contributes to the evaluation of complications such as thrombosis without the need for contrast injection and/or radiation . CT angiography provides 3D imaging with a high degree of anatomic detail, and is often able to demonstrate complications as well as underlying causes such as tumors or vascular wall lesions or malformation, as in our case.…”

“…It should be performed in any patient with abdominal pain or US‐diagnosed IVC aneurysm . However, in some special cases, venography and interventional radiology are necessary, especially when endovascular treatment is considered in selected patients without complication …”

The striated vascular sign

“…The striated vascular sign, also known as the threads and streaks sign, refers to the imaging identification of abnormal vessels within a venous lumen [1][2][3][4][5]. The sign indicates intravascular extension of vascularized tumor thrombus.…”

“…In addition to renal neoplasms, tumor thrombus from hepatocellular and adrenocortical carcinomas can be diagnosed by the familiarity with this sign which is more than a half-century old [3][4][5]. …”