IVC Pathology

Abdominal Vessels Pathology

• Focus on the inferior vena cava (IVC)

IVC Examination Techniques

• Ultrasound Evaluation:

  • Can be examined in both transverse and sagittal directions.

  • Well visualized in the epigastric area adjacent to the aorta, in front of the vertebral body.

  • Often observed near the upper part of the liver where it receives three main hepatic veins.

IVC Dimensions

• Typically measures less than 2.5 cm.

• During forced inspiration, the IVC collapses, reducing its diameter to approximately one-third of its original value.

IVC vs. Aorta Comparison

• Aorta:

  • Thick echogenic walls.

  • Pulsatile nature.

  • High flow velocity.

  • Incompressible.

  • Exhibits no respiratory variation.

• IVC:

  • Thin walls.

  • Not pulsatile.

  • Low flow velocity.

  • Compressible.

  • Shows respiratory variations.

IVC/Aorta Flow Measurements

• IVC Flow Velocity:

  • Measured at different points with variations in flow velocity observed.

  • Example values: +43.7 cm/s IVC flow; -0.87 m/s proximal aorta.

IVC Pathology

• Commonly leads to obstruction resulting in dilation of IVC due to right-sided heart failure.

IVC Tumors

• Various malignancies linked to IVC with renal cell carcinoma as the most prevalent.

  • Intravascular Tumor Extension:

    • May extend from the renal vein into the IVC and potentially travel as far as the heart.

    • Can cause partial or complete occlusion of the IVC.

Ultrasound Findings for IVC Tumor

• Detection of single or multiple echogenic nodules along the IVC wall.

• Possible distension and filling of IVC by the tumor.

IVC Thrombosis

• Development of a blood clot in the vein which can be life-threatening.

• Clinical Signs:

  • Leg edema.

  • Low back pain.

  • Pelvic pain.

  • Gastrointestinal complaints.

Ultrasound Findings for IVC Thrombosis

• Presence of echogenic material within the vein or a non-visualized vein.

Renal Vein Thrombosis (RVT)

• Involves a blood clot in one or both renal veins.

• Symptoms:

  • Can be asymptomatic or may include mild pain in the lower back/side.

  • Visible blood in the urine.

Causes of Renal Vein Thrombosis

• May arise from:

  • Abdominal or back injury.

  • Malignant kidney tumors infiltrating renal veins.

  • Kidney diseases such as Nephrotic Syndrome causing degenerative changes.

Ultrasound Findings for Renal Vein Thrombosis

• Lack of venous flow and presence of inverted arterial diastolic flow.

• B-mode ultrasound shows echogenic thrombus within the renal vein.

Treatment Strategies for RVT

• Aimed at preventing new clot formation and minimizing embolization risk:

  • Administration of anticoagulants.

  • Recommendations for bed rest or limited activity for a short duration.