Imaging the Inferior Vena Cava: A Road Less Traveled

Abstract

A broad spectrum of congenital anomalies and pathologic conditions can affect the inferior vena cava (IVC). Most congenital anomalies are asymptomatic; consequently, an awareness of their existence and imaging appearances is necessary to avoid misinterpretation. Imaging also plays a central role in the diagnosis of Budd-Chiari syndrome secondary to membranous obstruction of the intrahepatic IVC. Primary malignancy of the IVC is far less common than intracaval extension of malignant tumors arising in adjacent organs, and imaging can accurately help determine the presence and extent of tumor thrombus, information that is crucial for surgical planning. However, the radiologist should be aware that artifactual filling defects at computed tomography and magnetic resonance imaging can mimic true thrombus in the IVC and must be able to differentiate true from pseudo filling defects. Other imaging findings such as flat IVC and early enhancement of the IVC are useful in limiting the differential diagnosis. Familiarity with the imaging features of the various congenital and pathologic entities that can affect the IVC is paramount for early diagnosis and management.

Variant ventral intrahepatic course of inferior vena cava: volume-rendering and maximum intensity projection CT findings

“…Since the development of cross-sectional imaging, congenital anomalies of the inferior vena cava (IVC) and its tributaries have been encountered more frequently in asymptomatic patients [1,2]. Vascular structures are usually readily identified on CT scans of the abdomen and pelvis obtained with intravenously administered contrast material.Multiple congenital anomalies of IVC have been described in the literature including left-sided IVC, double IVC, azygos continuation of the IVC, circumaortic left renal vein and retroaortic left renal vein [3,4]. Other anomalies include the absence of the infrarenal IVC or the entire IVC.…”

Multidisciplinary Retroperitoneal and Pelvic Soft-Tissue Sarcoma Case Conferences: The Added Value that Radiologists Can Provide

“…In the clinical vignette, location is key for the accurate diagnosis of a leiomyosarcoma. The initial imaging modality used is often ct, and identifying the tumour as "intravascular" and "within the ivc" is highly specific for the diagnosis, with a limited differential 5 . In other cases, a retroperitoneal mass can be extremely large, with obliteration of fat planes, making the exact site of organ origin difficult to determine.…”

“…In tumours that are borderline resectable, or that are resectable but of high grade, neoadjuvant radiation or chemotherapy might be recommended before surgery. For leiomyosarcomas of the ivc, surgical resectability depends on the location: 50.8% arise from the middle ivc, 44.2% from the lower ivc, and 4.2% from the upper ivc (the latter being least amendable to surgical resection) 5 . Resection of the tumour with the ivc en bloc, with venous reconstruction, is often required.…”

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“…Other important clinical situation occurs in transjugular insertion of IVC filter that may be very difficult to be performed in the presence of such a variant (4) . The infrahepatic segment of the IVC develops between the sixth and eighth weeks of embryonic life, as a structure formed by anastomosis and partial, non simultaneous, resorption of three paired embryonic veins (5) . The location of the IVC at left results from the regression of the right supracardinal vein with persistence of the left supracardinal vein.…”

“…The ideal study phase for evaluating the IVC is at approximately 40-60 seconds after intravenous contrast injection, depending on the patient's clinical conditions. A possible imaging finding in cases of IVC location at left is higher attenuation of the right renal vein as compared with the left renal vein, as a function of the lower dilution of the venous return in lower limbs relatively without contrast agent (5) . However, it is extremely important that an active search for such variants is undertaken, event at non-contrast enhanced CT scans performed for different abdominal causes, considering that probably such imaging scan will be the only method capable of making a diagnosis and preventing any type of iatrogenic condition in a future procedure.…”