ABDOMINAL - INFERIOR VENA CAVA

the ivc is _____ to the aorta above the umbilicus, _____ to the aorta below the umbilicus

anterior, posterior

the ivc returns blood from

legs and non-digestive abdominal organs to heart

eustachian valve

flap of tissue at the junction of the ivc and the right atrium, is necessary for fetal circulation (persisting eustachian valves in adults have no effect on circulation)

deep inspiration (when held) _____ the diameter of the ivc

increases (due to increased intra-abdominal pressure)

expiration _____ the diameter of the ivc

decreases (with decrease of intra-abdominal pressure)

abnormal dilation in upper abdominal segment

over 2.5 cm

abnormal dilation at junction w hepatic veins

over 2.1 cm

tributaries of the ivc

• common iliac veins

• lumbar veins

• gonadal veins

• renal veins

• hepatic veins

largest tributaries of the ivc

hepatics

the left gonadal vein empties into the

left renal vein

the right gonadal vein empties into the

ivc

a duplication of the ivc most commonly begins below

the level of the renal veins

interruption of the ivc

intrahepatic segment of the ivc doesn’t develop, azygos vein drains flow from pelvis and lower extremities into the svc, hepatics drain directly into the right atrium

if there are other circulatory issues, the ivc will act as

a reservoir for blood

the ivc should collapse _____% or more with a quick sniff

50

dilation and loss of respiratory phasicity in the ivc can be caused by

• chf

• pulmonary htn

• decreased cardiac function

• electrolyte imbalance

• renal dysfunction

chf will cause _____ pulsatility throughout the venous system, including the legs

increased

how to differentiate tumor invasion of the ivc vs thrombus

tumor invasion will show internal vascularity while thrombus will not

severe tricuspid regurg can lead to _____ and _____, causing increased systolic flow reversal in the hepatics

chf, ivc dilation

_____ flow in the portal veins is also associated w chf and ivc dilation

biphasic

ivc aneurysm - most common type

saccular

type I ivc aneurysm

occurs in suprahepatic ivc without venous obstruction

type II ivc aneurysm

associated w interruption of ivc above or below the hepatic veins

type III ivc aneurysm

occurs in infrarenal ivc without associated venous anomaly

type IV ivc aneurysm

left sided ivc with an aneurysm at the confluence of the left internal and external iliac veins

in duplicated ivc, the left ivc joins the _____ and crosses the midline to join the right ivc before going to the rigth atrium

left renal vein

the right hepatic drains the right lobe and divides it into

anterior and posterior segments

the left hepatic drains the left lobe and divides it into

medial and lateral segments

the middle hepatic drains both of the lobes and divides the liver into

left and right lobes

the caudate lobe is drained by the _____ veins

emissary

what happens to the caudate lobe as a result of being drained by a separate drainage system

it is spared by complications caused by hepatic venous outflow obstruction

indications to scan the hepatic veins

• chf

• budd chiari

• significant tri regurg

• thrombosis

• liver tumor

normal hepatic vein waveform

triphasic

#1 cause of budd chiari

thrombus

budd chiari syndrome

• thrombus

• stenosis

• membrane

• compression

• tumor

hepatomegaly is seen in _____ budd chiari

acute

caudate lobe hypertrophy is seen in _____ budd chiari

acute

marked ascites is seen in _____ budd chiari

acute

hepatic veins are hard to see due to fluid accumulation in _____ budd chiari

acute

right lobe atrophy and fibrosis is seen in _____ budd chiari

chronic

splenomegaly is seen in _____ budd chiari

chronic

the hepatic vein walls thicken and become hard to see in _____ budd chiari

chronic

in budd chiari, portal vein flow will become

slow or reversed

nutcracker syndrome

sma compresses the left renal vein against the aorta

what can nutcracker syndrome lead to

• left renal vein thrombosis

• left renal vascular congestion

• scrotal varicocele

renal vein thrombosis is most commonly caused by

primary renal disease

gonadal veins drain blood from

the testicles or ovaries

why is there a higher chance of left sided varicocele

the left gonadal vein empties into the left renal vein and not directly into the ivc like the right gonadal vein

why is the valsalva maneuver performed when looking for varicocele

increases varicocele vessel size and demonstrates reflux on doppler

ovarian vein compression syndrome

the ovarian vein crosses anterior to the ureter as it courses cephalad to join the ivc/left renal vein. a dilated ovarian vein can cause notching or obstruction of the ipsilateral ureter

signs of acute renal vein thrombosis

• enlarged kidney on the affected side

• diastolic flow reversal in renal arteries

• increased parenchymal resistance in arcuate arteries