On all imaging, they appear as persistent fillingdefects within the inferior vena cava. Current murine models of inferior vena cava ivc vt model host one. Due to the substantial increase in the number of ivc filters placed in the united states and the very low filter. How is an inferior vena cava ivc filter used to treat. Primary tumor of the ivc primary tumors of the ivc are exceedingly rare. Superior vena cava thrombosis is a potentially lifethreatening clinical entity that mainly arises from the use of central venous catheters that may promote thrombosis and obstruction of this major vessel. Introduction inferior vena cava ivc thrombosis is a lifethreating condition in which early diagnosis has both therapeutic and prognostic importance. Filter retrieval was also performed to prevent risks from prolonged implantation and. Due to the protean clinical presentation of ivc thrombosis, clinical diagnosis is dif ficult and imaging examination is. Excimer laserassisted removal of embedded inferior vena. Excimer laserassisted removal of embedded inferior vena cava. Research finds the main cause of inferior vena cava thrombosis.
In absence of a congenital anomaly, the most common cause of ivc thrombosis is the presence of an unretrieved ivc. We retrospectively evaluated the clinical and imaging data of patients who had a recoverysup tm ivc filter placed between january 2003 and december 2004 in our institution. Inferior vena cava ivc involvement by intraluminal extension of tumor is infrequent, occuring in 4% to 10% of patients with renal cell carcinoma rcc 15. Ivc thrombus was noted by duplex in two patients who underwent gf. Ivc thrombosis ranges in severity of clinical presentation, but can lead to significant morbidity and mortality with incidence rates depending on patient population and type of filter used. In the absence of neoplasm, extension of leg vein thrombosis into the ivc is unusual, in most cases terminating at or below the iliac veins. Inferior vena cava ivc thrombosis is related to the pathological and clinical spectrum of deep venous thrombosis dvt. This option is most commonly indicated for deep venous thrombosis dvt or pulmonary embolism pe when blood thinning therapy is not advisable. Superior vena cava svc syndrome is most commonly the insidious result of decreased vascular flow through the svc due to malignancy, spontaneous thrombus, infections, and iatrogenic etiologies. Magnetic resonance imaging of deep venous thrombosis with. We present a case of ivc thrombosis in an otherwise healthy and active 28yearold male soldier secondary to dehydration and venous webbing. A prominent azygos vein, a paravertebral venous plexus, and lumbar veins were seen fig 1. The code is not valid for the year 2020 for the submission of hipaacovered transactions. Due to the protean clinical presentation of ivc thrombosis, clinical diagnosis is dif ficult and imaging examination is necessary to confirm or reject the presence of ivc thrombus.
However, it is not clear whether early recognition of. Thrombosis of the inferior vena cava ivc is an underrecognized entity with a variety of clinical presentations. Special software and workstations were used in reconstruction of raw data. In absence of a congenital anomaly, the most common cause of ivc thrombosis is the presence of an unretrieved ivc filter. Inferior venacavography is performed through the right internal jugular ij vein or either common femoral vein cfv. Inferior vena cava filters for recurrent thrombosis. Longterm safety and effectiveness of the optease vena.
Ultrasound detection of superior vena cava thrombus the. Jul 05, 2018 if you cant take a blood thinner or if one doesnt help, your doctor may insert a small, coneshaped filter inside your inferior vena cava. An inferior vena cava ivc filter is a medical device that is placed in the large vein in the abdomen in order to prevent blood clots originating in the legs from reaching the lungs. Tilt and caval penetration among permanent and retrievable. Background most patients with primary intracerebral hemorrhage developing clinically apparent proximal deep vein thrombosis dvt andor pulmonary embolism pe require treatment with either anticoagulants or inferior vena cava filter insertion. Ct and ultrasound have greatly facilitated early diagnosis, and the features of superior mesenteric and portal vein thrombosis are well recognized. Clinical case vascular inferior vena cava thrombosis. It can be a source of critical information for referring clinicians, and recognition of ivc variants and pathologic characteristics can help guide patient treatment. However, the implications and complexity of ivc thrombosis ivct merit specific attention. N2 recurrent deep venous thrombosis and inferior vena cava ivc thrombosis are welldescribed complications following ivc filter placement. Thrombosis of the inferior vena cava ivc is an underrecognized entity that is associated with significant short and longterm morbidity and mortality. Vena cava duplex imaging before caval interruption sciencedirect.
Coronal mri of the abdomen, using 2d fast imaging employing. Thus study aimed to evaluate the efficacy of surgical resection and prognosis after surgery for such cases. Spontaneous inferior vena cava thrombosis radiology case. Perinatal inferior vena cava thrombosis and absence of the. Guidelines and the use of inferior vena cava filters. Inferior vena cava ivc thrombosis is a lifethreatening condition that is rarely diagnosed in the postpartum period. Inferior vena caval thrombosis differential diagnoses. Inferior vena caval thrombosis statpearls ncbi bookshelf. Inferior vena cava thrombosis abstract thrombosis of the inferior vena cava ivc is an underrecognized entity that is associated with signi. It is formed by the joining of the right and the left common iliac veins, usually at the level of the fifth lumbar vertebra. Recurrent deep venous thrombosis and inferior vena cava ivc thrombosis are welldescribed complications following ivc filter placement. Sep 24, 20 retrieval indications included filterrelated acute inferior vena cava thrombosis, chronic inferior vena cava occlusion, and pain from retroperitoneal or bowel penetration.
The remaining 124 patients had diagnoses other than svc syndrome, including occlusion or thrombosis of the inferior vena cava and thrombosis or stricture of the subclavian or internal jugular vein. Imaging evaluation of the inferior vena cava radiographics. Between january 1990 and december 2012, 891 patients underwent. Vena cava filter occlusion and venous thromboembolism risk. Inferior vena cava definition of inferior vena cava by the. It is associated with a wide variety of congenital and pathologic processes and can be a source of vital information for. The code is valid for the year 2020 for the submission of hipaacovered transactions. Renal cell carcinoma rcc are accompanied by inferior vena cava ivc thrombus in up to 10% of the cases, with surgical resection remaining the only curative option. At the end we discuss the place of abdominal ultrasound in the evaluation of these patients. Introduction while the treatment of choice for deep vein thrombosis dvt and pulmonary embolism pe is anticoagulation therapy 1. Inferior vena cava ivc thrombosis is an underrecognized entity that is associated with significant morbidity and mortality. Ivc thrombosis remains underrecognised, as it is not commonly pursued or identified.
Ivc thrombus can be classified under two broad headings. Ivc inferior vena cava, mrv magnetic resonance venography fig. Inferior vena caval thrombosis radiology reference article. Retrieval indications included filterrelated acute inferior vena cava thrombosis, chronic inferior vena cava occlusion, and pain from retroperitoneal or bowel penetration.
Inferior vena cava definition of inferior vena cava by. Imaging evaluation of the inferior vena cava1 the inferior vena cava ivc is an essential but often overlooked structure at abdominal imaging. Its walls are rigid and it has valves so the blood does not flow down via gravity. Superior vena cava syndrome associated with massive. Retrievable ivc filters have become an increasingly attractive option due to the longterm risks of permanent filter placement.
It is also important to differentiate bland thrombus from tumor thrombus. T1 inferior vena cava filterrelated thrombusdeep vein thrombosis. The inferior vena cava ivc is the main conduit of venous return to the right atrium from the lower extremities and abdominal viscera. The initial diagnosis can be made on clinical grounds. Considerations for imaging the inferior vena cava ivc with. Imaging features of uterine leiomyomatosis with the inferior vena cava and the right atrium involvement. Mr imaging in inferior vena cava thrombosis sciencedirect. Kilbyinferior vena cava thrombosis following a cycle ride. Preclinical model to study recurrent venous thrombosis in the. Imaging primary and secondary tumor thrombus of the inferior vena cava. It is associated with a wide variety of congenital and pathologic processes and can be a source of vital information for referring clinicians. Inferior vena cava filterrelated thrombusdeep vein.
Chronic thrombosis can lead to pericaval and periaortic collateral formation. Although the latter probably reduces the immediate risk of incident or recurrent pe and surmounts. Inferior vena cava ivc filters are used as an alternative to anticoagulants for prevention of fatal pulmonary embolism pe in venous thromboembolic disorders. These devices are shown to be technically feasible in insertion and retrieval percutaneously while. However, when a patient in respiratory distress requires.
The purpose of this article is to increase knowledge of both congenital ivc. Inferior vena caval thrombosis radiology reference. When the superior vena cava be comes occluded, invaded by tumor, or com pressed. Anomalies of the inferior vena cava in patients with deep. In case of ivc wall invasion, the operative procedure is more challenging and may even require ivc resection. In nonclinical testing with body coil excitation, the crux vena cava filterproduced a maximal differentialtemperature rise of 4. Ultrasound imaging of inferior vena cava thrombosis. Swelling of the head and neck, flushing, cyanosis, respiratory distress, and neurological deficits comprise the clinical presentation. Thrombus may form within the filter and propagate, reducing filter patency and lower extremity venous return, promoting stasis and increasing the risk of dvt caudad to the filter. The purpose of the study was to assess the clinical safety and efficacy of the recoverysup tm bard inferior vena cava ivc filter. Inferior vena caval ivc thrombosis is an essential diagnosis while evaluating any neoplastic lesion, or portal hypertension.
The jugular route must be taken in patients with bilateral common femoral, iliac vein, or inferior vena cava ivc thrombosis. Thrombosis of the inferior vena cava is less common than deep venous thrombosis of the lower extremities, particularly in the absence of an obvious congenital caval abnormality or hypercoagulable state. Inferior vena cava ivc thrombosis remains underrecognised as it is often. Idiopathic thrombosis of the inferior vena cava and.
Clinical suspicion usually leads to computed tomography to confirm the diagnosis. A congenitally absent inferior vena cava ivc is a rare anomaly that is recognised to be associated with idiopathic deep venous thrombosis dvt, particularly in the young. Leiomyosarcoma of the ivc is a tumor of mesenchymal origin arising from the smoothmuscle cells found in the vessel wall and is associated with a poor prognosis. Mrv shows bloodfilling defects in inferior rhvs white arrow and ivc black arrow, which were partly thrombosed. The general concepts of deep venous thrombosis dvt and thrombophlebitis are discussed in detail in deep venous thrombosis. Although the latter probably reduces the immediate risk of incident or recurrent pe and surmounts the undefined risk of recurrent intracranial. Anticoagulation or inferior vena cava filter placement for.
Indwelling retrievable inferior vena cava filter for venous thromboembolism, now tolerating. Radiologic management of venous thromboembolisminferior vena. This study aims to determine the diagnostic performance of contrastenhanced magnetic resonance imaging mri for the. Clinical and radiographic predictors of the need for inferior vena. When the superior vena cava be comes occluded, invaded by tumor, or com pressed, blood. Full text ijv collapsibility index vs ivc collapsibility. Apr 11, 2016 thrombosis of the inferior vena cava ivc is an underrecognized entity that is associated with significant short and longterm morbidity and mortality. Retrospectively, as discussed in this case, there can be clues indicating the presence of such an anomaly from a young age. While imaging is a reliable method to investigate ivc anomalies, most radiologists and. In the puerperal setting it is presumably the result of extension of clot from either the iliac or ovarian veins. Magnetic resonance venography findings of obstructed.
Longterm safety and effectiveness of the optease vena cava. Realtime sonographic guidance is mandatory for ij vein puncture and is helpful for access at the groin. Inspace software siemens healthcare, where multiplanar. Treatment resulted in complete resolution of the svcs symptoms. Congenital absence of inferior vena cava and thrombosis. Sonographic detection of isolated inferior vena cava thrombosis. Perinatal inferior vena cava thrombosis and absence of the infrarenal inferior vena cava.
To our knowledge, this entity has not been reported in the radiologic literature. Findings include narrowing of the retrohepatic segment, demonstration of an intraluminal thrombus, distention of the ivc and hvs, and imaging features of. Iliescu b, haskal zj 2012 advanced techniques for removal of retrievable inferior vena cava filters. Katsamouris aa, waltman ac, delichatsios ma, athanasoulis ca 1988 inferior vena cava filters. The inferior vena cava is formed by the joining of the left and right common iliac veins and brings collected blood into the right atrium of the heart.
The prognosis for advanced hepatocellular carcinoma hcc with tumor thrombi in the inferior vena cava ivc or right atrium ra is poor, and there is no established effective treatment for this condition. Surgical management of hepatocellular carcinoma with tumor. Spectrum of congenital anomalies of the inferior vena cava. Considerations for imaging the inferior vena cava ivc. Ultrasound imaging of inferior vena cava thrombosis robert goiney, md obstruction of the inferior vena cava ivc may be secondary to a number of causes, including tumor extension from renal cell carcinoma, 1 ex trinsic compression, 2 and ligation or thrombus ex tension from pelv ic venous thrombus. Two patients with superior vena cava syndrome svcs associated with massive thrombosis were treated by means of local thrombolytic therapy and placement of modified gianturco expandable wire stents. Echocardiography of the inferior vena cava in healthy subjects and in patients with cardiac disease. Based on the cephalic extension of the thrombus, mayo 6 described a classification of inferior vena cava thrombi in 4 categories, which has implications on surgical complexity, estimated blood loss ebl and perioperative. Sep 29, 2014 volume 15, issue 6, september 2014 aaron birch, md et al. Superior vena cava obstruction evaluation with mdct ajr. It also joins with the azygos vein which runs on the right side of the vertebral column and venous plexuses next to the spinal cord. How is an inferior vena cava ivc filter used to treat deep. Magnetic resonance imaging is very useful in the detection of central deep venous thrombosis and anomalous inferior vena cava and should be considered in young patients with postoperative deep venous thrombosis.
Narrowing of the upper abdominal inferior vena cava in patients with elevated intraabdominal pressure. Multiple imaging modalities are potentially useful when ivc thrombosis is suspected. Transjugular or transfemoral insertion of ivc filters may result in clinically significant complications, such as vena cava thrombosis, insertionsite thrombosis, intravascular migration, vena cava perforation, and recurrent dvt or pe. What is the role of imaging in the diagnosis of inferior vena cava ivc. Appearance is most suggestive of adrenocortical carcinoma with ivc extension. A total of 15 healthy volunteers and six patients with ultrasoundverified proximal deep vein thrombosis dvt were examined from the inferior vena cava ivc to the proximal calf veins. Coronal reconstruction image from contrastenhanced ct in venous phase shows large heterogeneously enhancing mass arrows displacing right kidney inferiorly and filling defect arrowhead in hepatic portion of inferior vena cava ivc. Filter retrieval was also performed to prevent risks from prolonged implantation and to potentially eliminate the need for lifelong anticoagulation.