Membranous Obstruction of the Inferior Vena Cava: An Ultrasound, Computed Tomography, and Inferior Vena Cavogram Image Correlation
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The purpose of this paper is to present the computed tomography (CT) and ultrasound findings in one case of membranous obstruction of the inferior vena cava (IVC). Although the incidence of membranous obstruction of the IVC is rare in the United States, the diagnosis is essential because of the association of this lesion with portal fibrosis and hepatocellular carcinoma. Membranous obstruction of the IVC is suggested by the findings of a filling defect within the IVC at the level of either the diaphragm or right atrium. Until more specific CT and ultrasound features are described, an inferior vena cavogram will remain the definitive diagnostic procedure for membranous obstruction of the IVC. Index Terms: Vena cavae, obstruction—Veins, hepatic—Computed tomography—Ultrasound.The inferior vena cava (IVC) is an uncommon site for primary pathologies and secondary involvement is also infrequent, but involvement of the IVC can often drastically change management. It is therefore important to be cognizant of IVC pathologies. This review discussed common and rare neoplastic and non-neoplastic pathologies of the IVC as well as pathology mimics. Primary and secondary neoplasms can lead to tumour extension or bland thrombus formation and it is often important to distinguish between these two entities. It is also important to be aware of pseudo-lesions for accurate diagnosis. Inferior vena cava filter placement and endovascular treatment of the aorta are commonly performed procedures that can be associated with devastating complications, which are luckily infrequent. The calibre of the IVC also has its own clinical significance. Inferior vena cava pathologies, although rare, have a dramatic impact on the patient's outcome and knowledge of these pathologies is prudent.Understand the principles of IVC imaging, the common as well as the rare primary and secondary IVC tumours, differentiate between tumour thrombus and bland thrombus, and recognise IVC lesion mimics and life-threatening pathologies involving the IVC.
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Hepatic hemangioma is usually detected on a routine ultrasound examination because of silent clinical behaviour. The typical ultrasound appearance of hemangioma is easily recognizable and quickly guides the diagnosis without the need for further investigation. But there is also an entire spectrum of atypical and uncommon ultrasound features and our review comes to detail these particular aspects. An atypical aspect in standard ultrasound leads to the continuation of explorations with an imaging investigation with contrast substance [ultrasound/ computed tomography/or magnetic resonance imaging (MRI)]. For a clinician who practices ultrasound and has an ultrasound system in the room, the easiest, fastest, non-invasive and cost-effective method is contrast enhanced ultrasound (CEUS). Approximately 85% of patients are correctly diagnosed with this method and the patient has the correct diagnosis in about 30 min without fear of malignancy and without waiting for a computer tomography (CT)/MRI appointment. In less than 15% of patients CEUS does not provide a conclusive appearance; thus, CT scan or MRI becomes mandatory and liver biopsy is rarely required. The aim of this updated review is to synthesize the typical and atypical ultrasound aspects of hepatic hemangioma in the adult patient and to propose a fast, non-invasive and cost-effective clinical-ultrasound algorithm for the diagnosis of hepatic hemangioma.
Contrast-enhanced ultrasound
Liver Hemangioma
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Objective To investigate the clinical value of two dimensional ultrasound combined with four dimensional ultrasound in the prenatal diagnosis of fetal malformation.Method 1 298 Cases with late pregnant women who accepted prenatal screening were selected.Two dimensional ultrasound and four dimensional ultrasound were used in the diagnosis of fetal malformation.After the delivery,the diagnostic accuracy of single ultrasound and combined ultrasound examination was analyzed.Results In the diagnosis of fetal malformation,the sensitivity of four dimensional ultrasound was higher than that of two dimensional ultrasound,but the difference was not significant(P 0.05).The specificity and the accuracy of four dimensional ultrasound were significantly higher than those of two dimensional ultrasound.The sensitivity,specificity,and accuracy of two dimensional ultrasound combined with four dimensional ultrasound were all significantly higher than those of two dimensional ultrasound,or four dimensional ultrasound,and the differences were significant(P 0.05).In the diagnosis of fetal surface malformations,the specificity and accuracy of four dimensional ultrasound were higher than those of two dimensional ultrasound.The sensitivity of two dimensional ultrasound combined with four dimensional ultrasound was higher than that of four dimensional ultrasound,but the differences were not significant(P 0.05).The sensitivity of four dimensional ultrasound or two dimensional ultrasound combined with four dimensional ultrasound was significantly higher than that of two dimensional ultrasound.The specificity and accuracy of two dimensional ultrasound combined with four dimensional ultrasound were significantly higher than those of two dimensional ultrasound and four dimensional ultrasound,and the differences were significant(P 0.05).Conclusion Two dimensional ultrasound combined with four dimensional ultrasound can significantly improve the prenatal diagnostic accuracy of fetal malformations,which has a high clinical value and is worthy to be widely used in clinic.
3D ultrasound
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Introduction Change in inferior cava diameter (IVC) during respiration is a potentially non invasive measure of blood volume in haemodialysis (HD) and heart failure (HF) patients. We tested its sensitivity to acute volume loading in normal volunteers (NV). Methods 30 NV (16 male; 48.7 ± 8.6 years, range 48–63) received intravenous 0.9% saline (IVS; 1.5 L over 20 minutes). IVC was measured by M‐mode echocardiography in long‐(LAX) and short‐axis (SAX) views during expiration (IVCe), inspiration (IVCi) and maximal inspiration (IVCmi) at 0, 1, 2 and 4 h. IVC was corrected for body surface area (IVCD) and IVC collapsibility index (IVCCI) was defined as IVCCIi=[(IVCe‐IVCi)/IVCe] × 100. Results There was good linear correlation between LAX and SAX IVC [IVCe: r=0.809; p<0.0001 , IVCi: r=0.660; p<0.0001 and IVCmi: r=0.498; p=0.005 ]. Parameters increased following IVS, with greater change from baseline in SAX. Only IVCe and IVCDe in SAX increased significantly following IVS (Table 1). Conclusions Despite good correlation between LAX and SAX, SAX inferior vena cava indices are more responsive to IVS in NV. Further studies to assess the utility of these indices in the routine care of HF and HD patients are indicated. Funding Haemostasis Thrombosis and Vascular Biology Unit charitable funds.
Expiration
Intravascular volume status
Body surface area
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The purpose of this study was to compare the performance between noncontrast-enhanced computed tomography (NECT) plus abdominal ultrasound (US) (NECT + US) with contrast-enhanced computed tomography (CECT) for the detection of hepatic metastasis in breast cancer patient with postsurgical follow-up.A total of 1470 patients without already diagnosed hepatic metastasis were included. All patients underwent US and multiphase CECT including the NECT. Independent reviewers analyzed images obtained in four settings, namely, abdominal US, NECT, NECT + US, and CECT and recorded liver metastases using a 5-grade scale of diagnostic confidence. Sensitivity, specificity (diagnostic performance), and area under the receiver operating characteristic curve (AUC, diagnostic confidence) were calculated. Interoperator agreement was calculated using the kappa test.Reference standards revealed no metastases in 1108/1470 patients, and metastasis was detected in 362/1470 patients. Abdominal US (P < 0.01) and NECT (P = 0.01) significantly differed from CECT, but NECT + US did not significantly differ from CECT in terms of sensitivity (P = 0.09), specificity (P = 0.5), and AUC (P = 0.43). After an additional review of abdominal US, readers changed the diagnostic confidence scores of 106 metastatic lesions diagnosed using NECT. Interobserver agreements were good or very good in all four settings. Additional review of abdominal US with NECT allowed a change in the therapeutic plan of 108 patients.Abdominal US + NECT showed better diagnostic performance for the detection of hepatic metastases than did NECT alone; its diagnostic performance and confidence were similar to those of CECT.
Contrast-enhanced ultrasound
Contrast Enhancement
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Objective To analyze the application value of ultrasound, MRI and CT in the diagnosis of primary gallbladder carcinoma. Methods The imaging data of 50 patients with primary gallbladder carcinoma confirmed by operation and pathology were retrospectively analyzed. All patients underwent ultrasound examination. 40 cases underwent CT examination and 25 cases underwent MRI examination. The imaging findings were observed and analyzed, respectively. Meanwhile, the findings were compared with the results of operation and pathological examination. The accuracy of the three kinds of examinations in the diagnosis of primary gallbladder carcinoma was compared. ResultsCompared with operation and pathological results, the diagnostic accordant rates(accuracy) of ultrasound, CT and MRI were 64.0%, 73.3% and 88.0%. The diagnostic accuracy of MRI was significantly higher than that of ultrasound, and the difference was statistically significant(P0.05). Conclusion Ultrasound, MRI and CT in the diagnosis of primary gallbladder carcinoma have their own advantages and disadvantages, and the diagnostic accordant rates of MRI was the highest while of ultrasound was the lowest.
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下大静脈（inferior vena cava;以下，IVC）へ浸潤または腫瘍栓を合併した腎・副腎癌は一般的に予後不良であるが，腫瘍栓による肺梗塞や心不全による突然死の回避目的や根治的切除による長期生存例の報告が散見される．今回われわれは，肝臓およびIVC浸潤またはIVC腫瘍栓を呈した腎細胞癌3例・副腎皮質癌2例の計5症例に対し，肝臓外科手技を応用した手術手技とその成績について検討した．結果，全肝血流遮断法を3例に行い，うち1例に大腿動静脈バイパスによる体外循環を併用した．肝直接浸潤の1症例に，後区域切除を行った．全症例で肉眼的根治術が可能であった．5例の平均生存期間は30.6カ月で，遠隔死亡は2例あった．従来手術困難とされた肝臓やIVCへの浸潤あるいはIVC腫瘍栓を合併した腎・副腎癌であっても，肝臓外科手技を応用し，心臓血管外科・泌尿器科共同による根治的切除で長期生存も期待しうると考えた．
Hepatic veins
Vena cava
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背景为 Budd-Chiari 症候群(英国计算机学会) 的治疗的几种激进的外科被设计了。我们描述了初步的努力用一种新奇激进的切除术技术对待英国计算机学会暴露肝的 segment.Methods 的全部劣等的静脉 cava (IVC ) 有英国计算机学会的六十个病人被激进的切除术对待，包括 46 个男人和 14 个女人。英国计算机学会病人从 11 ～ 62 年在年龄，与到自从 BCS 诊断的 11 年的 3 个月。损害在 16 个病人，包括了 IVC 的膜吸藏在在 2 个病人，的 IVC 以内的两倍膜在 3 个病人，在 IVC 和肝的静脉( HV )以内加倍膜有在 10 个病人的远侧的血栓的 IVC 膜，在 5 个病人的 IVC 的长片断血栓(在 2 个病人，的组织血栓在 3 个病人的新鲜血栓)， HV 的插头的吸藏由于在 2 个病人，的墙壁的血栓在 3 个病人，的 IVC 的部分吸藏在有 IVC 的 HV 以内的膜三个过程与血的汽车检索在身体外的循环，有正确中庭的 catheterization 的 52 个病人，有一个房间保护器的 4 个病人，和一个病人下面被执行。检索的血从 300 ml 到 4000 ml。存的血的输送从 400 ml 到为 14 个病人的 2000 ml。为另外的病人，存的血的输送都没被要求。一个病人 peri-operatively 死于肾的失败。最新形成的 IVC 膜被作出对有利的裁决血栓是其 IVC 的一个周期性的病人移开一个年优先。没有症状， IVC 的狭窄在一个病人 post-operatively 被观察。在另外的病人，没有周期性的症状在过程和收益期间在这个新奇手术提供的后续 periods.Conclusion 期间被发现清楚的视觉域令人满意的短、长期的结果。
Budd–Chiari syndrome
Hepatic veins
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症例は52歳の女性. 腹痛を主訴として前医受診, 手術にてIVC原発腫瘍と判明したため当院紹介された. IVC造影ではIVCの閉塞, 側副血行路の形成は見られなかった. 開腹すると腫瘍は中部IVCより壁外性に発育しており, 右腎静脈への浸潤を認めた. 右腎静脈を大伏在静脈にて再建した後, IVCの単純遮断下に腫瘍をIVCとともに切除し, IVCは人工血管にて再建した. 病理組織診断は平滑筋肉腫であった. 術後6か月のMRI検査ではIVCのpatencyは保たれていた. 術後17か月経過した現在, 再発の兆候なく外来通院中である. 下大静脈原発平滑筋肉腫は本邦での報告は自験例を含めて53例で, IVC切除後人工血管にて再建された症例は12例である. IVC切除にあたっては血流遮断時の体外循環の必要性, 腎静脈の処理方法などをIVC造影, 術中所見から判断することが重要である.
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