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The inferior vena cava: a pictorial review of embryology, anatomy, pathology, and interventions

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Abstract

The inferior vena cava (IVC) is the largest venous conduit below the diaphragm. Although this structure is often overlooked both clinically and radiographically, it can be involved in many different pathologic processes. A thorough understanding of the IVC will assist the radiologist in recognizing anatomic variants, identifying abnormalities, and providing accurate differential diagnoses. In this comprehensive pictorial review of the IVC, we depict embryology behind anatomic variants, present a wide range of pathology with a focus on diagnostic imaging, and describe relevant endovascular interventions.

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References

  1. Bass JE, Redwine MD, Kramer LA, Huynh PT, Harris JH, Jr. Spectrum of congenital anomalies of the inferior vena cava: cross-sectional imaging findings. Radiographics 2000;20:639-52.

    Article  CAS  PubMed  Google Scholar 

  2. Ginaldi S, Chuang VP, Wallace S. Absence of hepatic segment of the inferior vena cava with azygous continuation. Journal of computer assisted tomography 1980;4:112-4.

    Article  CAS  PubMed  Google Scholar 

  3. Haswell DM, Berrigan TJ, Jr. Anomalous inferior vena cava with accessory hemiazygos continuation. Radiology 1976;119:51-4.

    Article  CAS  PubMed  Google Scholar 

  4. Ettinger E, Steinberg I. Angiocardiographic measurement of the cardiac segment of the inferior vena cava in health and in cardiovascular disease. Circulation 1962;26:508-15.

    Article  Google Scholar 

  5. Prince MR, Novelline RA, Athanasoulis CA, Simon M. The diameter of the inferior vena cava and its implications for the use of vena caval filters. Radiology 1983;149:687-9.

    Article  CAS  PubMed  Google Scholar 

  6. Smillie RP, Shetty M, Boyer AC, Madrazo B, Jafri SZ. Imaging evaluation of the inferior vena cava. Radiographics 2015;35:578-92.

    Article  PubMed  Google Scholar 

  7. Kraft C, Schuettfort G, Weil Y, et al. Thrombosis of the inferior vena cava and malignant disease. Thrombosis research 2014;134:668-73.

    Article  CAS  PubMed  Google Scholar 

  8. Hollenbeck ST, Grobmyer SR, Kent KC, Brennan MF. Surgical treatment and outcomes of patients with primary inferior vena cava leiomyosarcoma. Journal of the American College of Surgeons 2003;197:575-9.

    Article  PubMed  Google Scholar 

  9. Sheth S, Scatarige JC, Horton KM, Corl FM, Fishman EK. Current concepts in the diagnosis and management of renal cell carcinoma: role of multidetector ct and three-dimensional CT. Radiographics 2001;21 Spec No:S237-54.

  10. Psutka SP, Boorjian SA, Thompson RH, et al. Clinical and radiographic predictors of the need for inferior vena cava resection during nephrectomy for patients with renal cell carcinoma and caval tumour thrombus. BJU international 2015;116:388-96.

    Article  PubMed  Google Scholar 

  11. Neves RJ, Zincke H. Surgical treatment of renal cancer with vena cava extension. British journal of urology 1987;59:390-5.

    Article  CAS  PubMed  Google Scholar 

  12. Al Diab A, Hirmas N, Almousa A, et al. Inferior vena cava involvement in children with Wilms tumor. Pediatric surgery international 2017;33:569-73.

    Article  PubMed  Google Scholar 

  13. Khanna G, Rosen N, Anderson JR, et al. Evaluation of diagnostic performance of CT for detection of tumor thrombus in children with Wilms tumor: a report from the Children’s Oncology Group. Pediatric blood & cancer 2012;58:551-5.

    Article  Google Scholar 

  14. Ng L, Libertino JM. Adrenocortical carcinoma: diagnosis, evaluation and treatment. The Journal of urology 2003;169:5-11.

    Article  PubMed  Google Scholar 

  15. Libe R, Borget I, Ronchi CL, et al. Prognostic factors in stage III-IV adrenocortical carcinomas (ACC): an European Network for the Study of Adrenal Tumor (ENSAT) study. Annals of oncology : official journal of the European Society for Medical Oncology 2015;26:2119-25.

    Article  CAS  Google Scholar 

  16. Chang JY, Ka WS, Chao TY, Liu TW, Chuang TR, Chen LT. Hepatocellular carcinoma with intra-atrial tumor thrombi. A report of three cases responsive to thalidomide treatment and literature review. Oncology 2004;67:320-6.

  17. Kaneko T, Nakao A, Nomoto S, Endo T, Itoh S, Takagi H. Intracaval endovascular ultrasonography for preoperative assessment of retrohepatic inferior vena cava infiltration by malignant hepatic tumors. Hepatology (Baltimore, Md) 1996;24:1121-7.

    Article  CAS  Google Scholar 

  18. Armstrong PJ, Franklin DP. Pararenal vena cava leiomyosarcoma versus leiomyomatosis: difficult diagnosis. Journal of vascular surgery 2002;36:1256-9.

    Article  PubMed  Google Scholar 

  19. Peng HJ, Zhao B, Yao QW, Qi HT, Xu ZD, Liu C. Intravenous leiomyomatosis: CT findings. Abdominal imaging 2012;37:628-31.

    Article  PubMed  Google Scholar 

  20. Wachtel H, Gupta M, Bartlett EK, et al. Outcomes after resection of leiomyosarcomas of the inferior vena cava: a pooled data analysis of 377 cases. Surgical oncology 2015;24:21-7.

    Article  PubMed  Google Scholar 

  21. Mingoli A, Cavallaro A, Sapienza P, Di Marzo L, Feldhaus RJ, Cavallari N. International registry of inferior vena cava leiomyosarcoma: analysis of a world series on 218 patients. Anticancer research 1996;16:3201-5.

    CAS  PubMed  Google Scholar 

  22. Kulaylat MN, Karakousis CP, Doerr RJ, Karamanoukian HL, O’Brien J, Peer R. Leiomyosarcoma of the inferior vena cava: a clinicopathologic review and report of three cases. Journal of surgical oncology 1997;65:205-17.

    Article  CAS  PubMed  Google Scholar 

  23. Kieffer E, Alaoui M, Piette JC, Cacoub P, Chiche L. Leiomyosarcoma of the inferior vena cava: experience in 22 cases. Annals of surgery 2006;244:289-95.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Sulpice L, Rayar M, Levi Sandri GB, et al. Leiomyosarcoma of the inferior vena cava. Journal of visceral surgery 2016;153:161-5.

    Article  CAS  PubMed  Google Scholar 

  25. Alkhouli M, Morad M, Narins CR, Raza F, Bashir R. Inferior Vena Cava Thrombosis. JACC Cardiovascular interventions 2016;9:629-43.

    Article  Google Scholar 

  26. McAree BJ, O’Donnell ME, Fitzmaurice GJ, Reid JA, Spence RA, Lee B. Inferior vena cava thrombosis: a review of current practice. Vascular medicine (London, England) 2013;18:32-43.

    Article  CAS  Google Scholar 

  27. Vogelzang RL, Gore RM, Neiman HL, Smith SJ, Deschler TW, Vrla RF. Inferior vena cava CT pseudothrombus produced by rapid arm-vein contrast infusion. AJR American journal of roentgenology 1985;144:843-6.

    Article  CAS  PubMed  Google Scholar 

  28. Hartley JW, Awrich AE, Wong J, Stevens K, Fletcher WS. Diagnosis and treatment of the inferior vena cava syndrome in advanced malignant disease. American journal of surgery 1986;152:70-4.

    Article  CAS  PubMed  Google Scholar 

  29. Oudkerk M, Heystraten FM, Stoter G. Stenting in malignant vena caval obstruction. Cancer 1993;71:142-6.

    Article  CAS  PubMed  Google Scholar 

  30. Devcic Z, Techasith T, Banerjee A, Rosenberg JK, Sze DY. Technical and Anatomic Factors Influencing the Success of Inferior Vena Caval Stent Placement for Malignant Obstruction. Journal of vascular and interventional radiology : JVIR 2016;27:1350-60.e1.

    Google Scholar 

  31. Davidovic L, Dragas M, Cvetkovic S, Kostic D, Cinara I, Banzic I. Twenty years of experience in the treatment of spontaneous aorto-venous fistulas in a developing country. World journal of surgery 2011;35:1829-34.

    Article  PubMed  Google Scholar 

  32. van Rooyen PL, Karusseit VO, Mokoena T. Inferior vena cava injuries: a case series and review of the South African experience. Injury 2015;46:71-5.

    Article  PubMed  Google Scholar 

  33. Buckman RF, Pathak AS, Badellino MM, Bradley KM. Injuries of the inferior vena cava. The Surgical clinics of North America 2001;81:1431-47.

    Article  CAS  PubMed  Google Scholar 

  34. Tsai R, Raptis C, Schuerer DJ, Mellnick VM. CT Appearance of Traumatic Inferior Vena Cava Injury. AJR American journal of roentgenology 2016;207:705-11.

    Article  PubMed  Google Scholar 

  35. Dipti A, Soucy Z, Surana A, Chandra S. Role of inferior vena cava diameter in assessment of volume status: a meta-analysis. The American journal of emergency medicine 2012;30:1414-9.e1.

    Google Scholar 

  36. Anand T, vanSonnenberg E, Gadani K, Skinner R. A snapshot of circulation failure following acute traumatic injury: The expansion of computed tomography beyond injury diagnosis. Injury 2016;47:50-2.

    Article  PubMed  Google Scholar 

  37. Takada H, Hifumi T, Yoshioka H, et al. Initial inferior vena cava diameter predicts massive transfusion requirements in blunt trauma patients: A retrospective cohort study. The American journal of emergency medicine 2018;36:1155-9.

    Article  PubMed  Google Scholar 

  38. Johnson JJ, Garwe T, Albrecht RM, et al. Initial inferior vena cava diameter on computed tomographic scan independently predicts mortality in severely injured trauma patients. The journal of trauma and acute care surgery 2013;74:741-5; discussion 5-6.

  39. Li Y, Zhang LY, Wang Y, Zhang WG. The flatness index of inferior vena cava is useful in predicting hypovolemic shock in severe multiple-injury patients. The Journal of emergency medicine 2013;45:872-8.

    Article  PubMed  Google Scholar 

  40. Liao YY, Lin HJ, Lu YH, Foo NP, Guo HR, Chen KT. Does CT evidence of a flat inferior vena cava indicate hypovolemia in blunt trauma patients with solid organ injuries? The Journal of trauma 2011;70:1358-61.

    Article  PubMed  Google Scholar 

  41. Matsumoto S, Sekine K, Yamazaki M, et al. Predictive value of a flat inferior vena cava on initial computed tomography for hemodynamic deterioration in patients with blunt torso trauma. The Journal of trauma 2010;69:1398-402.

    Article  PubMed  Google Scholar 

  42. Nguyen A, Plurad DS, Bricker S, et al. Flat or fat? Inferior vena cava ratio is a marker for occult shock in trauma patients. The Journal of surgical research 2014;192:263-7.

    Article  PubMed  Google Scholar 

  43. Smithson L, Morrell J, Kowalik U, Flynn W, Guo WA. Correlation of computed tomographic signs of hypoperfusion and clinical hypoperfusion in adult blunt trauma patients. The journal of trauma and acute care surgery 2015;78:1162-7.

    Article  PubMed  Google Scholar 

  44. Barber JL, Touska P, Negus AS. Inferior vena cava calibre on paediatric trauma CT may be a useful predictor for the development of shock. Clinical radiology 2016;71:565-9.

    Article  CAS  PubMed  Google Scholar 

  45. Milia DJ, Dua A, Paul JS, Tolat P, Brasel KJ. Clinical utility of flat inferior vena cava by axial tomography in severely injured elderly patients. The journal of trauma and acute care surgery 2013;75:1002-5; discussion 5.

  46. Entwisle KG, Watkinson AF, Hibbert J, Adam A. The use of the Wallstent endovascular prosthesis in the treatment of malignant inferior vena cava obstruction. Clinical radiology 1995;50:310-3.

    Article  CAS  PubMed  Google Scholar 

  47. Brountzos EN, Binkert CA, Panagiotou IE, Petersen BD, Timmermans H, Lakin PC. Clinical outcome after intrahepatic venous stent placement for malignant inferior vena cava syndrome. Cardiovascular and interventional radiology 2004;27:129-36.

    PubMed  Google Scholar 

  48. Kishi K, Sonomura T, Fujimoto H, et al. Physiologic effect of stent therapy for inferior vena cava obstruction due to malignant liver tumor. Cardiovascular and interventional radiology 2006;29:75-83.

    Article  PubMed  Google Scholar 

  49. Hesterberg K, Babu A, Frank M, Hogan S, Krantz MJ. Severe tricuspid regurgitation due to valvular entrapment of an inferior vena cava stent. Clinical case reports 2017;5:130-3.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Toyoda N, Torregrossa G, Itagaki S, Pawale A, Reddy R. Intracardiac migration of vena caval stent: decision-making and treatment considerations. Journal of cardiac surgery 2014;29:320-2.

    Article  PubMed  Google Scholar 

  51. Yamagami T, Nakamura T, Kato T, Iida S, Nishimura T. Hemodynamic changes after self-expandable metallic stent therapy for vena cava syndrome. AJR American journal of roentgenology 2002;178:635-9.

    Article  PubMed  Google Scholar 

  52. Herscu G, Woo K, Weaver FA, Rowe VL. Use of unconventional dialysis access in patients with no viable alternative. Annals of vascular surgery 2013;27:332-6.

    Article  PubMed  Google Scholar 

  53. Gupta A, Karak PK, Saddekni S. Translumbar inferior vena cava catheter for long-term hemodialysis. Journal of the American Society of Nephrology : JASN 1995;5:2094-7.

    CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Radiology, University of Washington, 1959 NE Pacific St, Box 357115, Seattle, WA, 98195, USA

    David S. Shin, Claire K. Sandstrom, Christopher R. Ingraham, Eric J. Monroe & Guy E. Johnson

  2. Department of Radiology, Seattle Children’s Hospital, Seattle, WA, USA

    Eric J. Monroe

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  1. David S. Shin
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  2. Claire K. Sandstrom
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Correspondence to David S. Shin.

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Shin, D.S., Sandstrom, C.K., Ingraham, C.R. et al. The inferior vena cava: a pictorial review of embryology, anatomy, pathology, and interventions. Abdom Radiol 44, 2511–2527 (2019). https://doi.org/10.1007/s00261-019-01988-3

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