IVC Abnormalties Flashcards
1
Q
With deep INSPIRATION, venous return _____ (increases/decreases) and the IVC _____ (increases/decreases).
A
decreases
decreases
2
Q
With deep EXPIRATION, venous return _____ (improves/decreases) and the IVC _____ (increases/decreases).
A
improves
increases
3
Q
When performing the Valsalva maneuver, venous return is _____ and flow temporarily _____ in the IVC causing it to bulge.
A
blocked
reverses
4
Q
Because IVC examinations need to be done in a consistant manner, it is usually best accomplished when the patient _____ inspiration.
A
suspends
5
Q
When the normal blood flow in the IVC is obstructed, the normal response of the vessel is to _____ (increase/decrease) in caliber _____ (above/below) the point of obstruction. Respiratory changes are _____ (increased/decreased) below the obstructed segment.
A
increase
below
decreased or absent
6
Q
The most common cause of IVC obstruction is
A
right-sided heart failure
7
Q
Other causes for IVC obstruction are (5)
A
1) enlarged liver
2) para-aortic lymph node enlargement
3) retroperitoneal masses or tumors
4) pancreatic tumors
5) a congenital IVC valve may obstruct the lumen of the IVC
8
Q
Symptoms of IVC obstruction may include (4)
A
1) abdominal pain
2) ascites
3) tender hepatomegaly
4) lower extremity edema (often in most severe forms of IVC obstruction)
9
Q
In right-sided heart failure, the distal IVC and hepatic veins (HVs) become congested, resulting in a(n) _____ (increase/decrease) in diameter. Respiratory changes are markedly _____(increased/decreased).
A
increase
decreased or absent
10
Q
“Respiratory changes” refers to the IVC _____ or _____ with breathing patterns.
A
compressing
dilating
11
Q
Sonographic signs and physical signs of CHF are (3)
A
1) Dilation of the IVC and HVs
2) Hepatomegaly
3) Ascites
12
Q
An indication that there is possible CHF and an US is needed is often
A
abnormal LFTs
13
Q
If large enough, a solid, complex, or echo-poor tumor in the retroperitoneum or pancreas may obstruct the IVC, causing lower trunk and leg _____.
A
edema
14
Q
Overall enlargement of the liver would cause the IVC to _____ (constrict/dilate) as it presses on the vessel.
A
dilate
15
Q
The most encountered intraluminal anomaly of the IVC is _____, which usually spreads from another vein in the pelvis, lower limb, liver, or kidney.
A
thrombus (clot)
16
Q
Typically, the more echogenic a thrombus is, the _____ (younger - acute/older - chronic) it is.
A
older - chronic
17
Q
T or F? A doppler of a thrombus produces no signal.
A
True
18
Q
Where is the most likely site of origin for a thrombus in the IVC?
A
kidneys
19
Q
The normal response of a vein below the point of obstruction will be _____ (dilation/constriction), but above the obstruction the vein should remain normal diameter.
A
dilation
20
Q
What is the metal device called that is made of either stainless steel or nitinol and placed in the IVC to trap clots that are 5mm or larger?
A
IVC filter
21
Q
T or F? Most IVC filters in the US are placed temporarily rather than permanantly.
A
False - they are usually permanant
22
Q
When an IVC filter fracture occurs, it means a fragment migrates to
A
adjacent tissues
23
Q
If an IVC fracture occurs without symptoms (asymptomatic), is treatment necessary?
A
no
24
Q
Tumors of the IVC may be _____, _____, or _____.
A
primary
metastatic
an extension from primary
25
A primary tumor of the IVC is one that
started in the IVC
26
A metastatic tumor of the IVC is one that
started in another organ and invaded the IVC
27
An extension from a primary tumor of the IVC is one that
a large tumor that grows from another adjacent organ
28
A leiomyoma is a _____ (benign/malignant) tumor of the smooth muscle.
benign
29
A leiomyasarcoma is a _____ (benign/malignant) tumor of the smooth muscle.
malignant
30
Primary tumors of the IVC are not very common, and have a vascular incidence of only ____%.
2%
31
Primary tumors, if any, tend to develop in _____ (men/women) and have a median age of detection at _____ years old.
women
| 61
32
With leiomyosarcomas, metastasis to the liver and lung has been reported in _____-_____% of cases. A _____% recurrence rate is also reported, and prognosis is _____ (good/poor).
40-50%
36%
poor
33
A mass _____ (has/doesn't have) color flow, a clot _____ (has/doesn't have) color flow.
has
| doesn't have
34
The most common incidence of metastasis/extension of tumors in the IVC is
renal carcinoma
35
If there is a primary tumor in the IVC (which is rare), it is most likely a _____ or a _____.
leiomyoma
| leiomyosarcoma
36
Tumors within the IVC tend to appear as _____ (echogenic/hypoechoic) foci.
echogenic
37
Large primary tumors of the IVC may be _____ (homogeneous/heterogeneous), with areas of necrosis.
heterogeneous
38
When an IVC mass is identified, it is important to attempt to identify (3)
1) the presence of a primary tumor
2) does it involve the HVs or right atrium (extent of cranial involvement)?
3) possible tumor involvement or invasion of the wall of the vessel
39
Doppler and color flow in the IVC is usually steady. When the IVC is partially obstructed, the blood velocity at the narrowed segment _____ (increases/decreases).
increases
40
When blood flow in the IVC is obstructed, the normal response of the vessel is to _____ (increase/decrease) in caliber _____ (above/below) the point of obstruction.
increase
| below
41
In right-sided heart failure, the distal IVC and HVs become _____, resulting in a(n) _____ (increase/decrease) in diameter.
congested
| increase
42
Malignant invasion or tumor extension of the IVC may occur from (6)
1) renal carcinoma
2) secreting/non-secreting adrenal tumors
3) retroperitoneal sarcomas
4) hepatocellular carcinoma
5) teratomas
6) lymphomas
43
What is the most common physical sign of an IVC tumor invasion?
leg edema
44
The most common reasons that renal veins enlarge are (3)
1) increased flow due to splenorenal/gastrorenal shunt or AV malformation in kidney
2) portal HTN or thrombosis
3) tumor involvement from renal cell carcinoma
45
T or F? Tumor involvement of the renal veins (RVs) usually produces no specific symptoms that would lead to suspicion of tumor extenstion.
True
46
T or F? Symptoms of the presence of an enlarged renal vein (RV) are generally associated with the initial disease process, not because of the actual venous enlargement.
True
47
An enlarged renal vein is one that exceeds
1.5 cm
48
Another sonographic finding that suggests increased flow into the renal vein is abrupt IVC dilation at the level of the _____ _____ _____.
renal insertion point
49
If enlargment of the RVs IS NOT bilateral or symmetric, this would indicate that the disease process _____ (does/does not) involve(s) the IVC at the level above the insertion of the RVs.
does not
50
If enlargement of the RVs IS bilateral or symmetric, this would indicate that the disease process _____ (does/does not) involve(s) the IVC at the level above the insertion of the RVs.
does
51
T or F? In portal HTN, several collateral pathways are apt to develop as the pressure in the portal system increases. These collateral pathways connect to _____ veins, and these are known as _____ veins.
True
systemic
varicose
52
In portal HTN, blood flow is diverted to the collaterals, which may in turn affect the LRV how and why?
The collaterals may fistulize to the LRV in order to alleviate pressure.
53
In portal venous HTN, is the LRV, RRV, or both typically involved? Why?
LRV
| Because collaterals that form loop around and reconnect to the LRV
54
If portal venous HTN occurs, the doppler flow will show blood _____ (entering/leaving) the liver because
leaving
| because the blood is being blocked from the liver and is forced to flow backwards
55
In tumor invasion or an AV fistula, is the LRV, RRV, or both typically involved (as compared to PV HTN vessel involvement).
LRV or RRV
56
It has been determined that the prevalence of RV involved in renal cell carcinoma is approximately _____ to _____%.
21% - 55%
57
When renal cell carcinoma invasion occurs, obstruction to the RV result in _____ (constriction/dilation).
dilation
58
What is the normal PV caliber?
13mm
59
Multiple worm-like serpiginous vessels in the region of the PV that result from longstanding thrombus and subsequent collateral vessel formation of a network of vessels that replace the obliterated PV is called
cavernomatous transformation
60
What is the acute or chronic hepatocellular disease that blocks the flow of blood through the liver, causing it to back up into the hepatic portal circulation and causes the blood pressure in the hepatic circulation to increase?
portal HTN
61
What helps to relieve high pressure in the portal system?
the formation of callateral vessels or varicose veins
62
Where do collateral vessels usually form (3)?
esophagus
stomach
rectum
63
What is the most clinical consequence of portal HTN?
variceal hemorrhage
64
What kind of blood flow is observed in patients with portal HTN?
hepatofugal or retrograde
65
Because of the variations in caliber of the IVC during respiration, it is imperative that examinations are done in a consistent manner. This is usually best accomplished by examining while the patient ______ inspiration.
suspends
66
The average measurment of an IVC is ______. Above ______ is considered abnormal.
2 cm - 3.7 cm
| 3.7 cm
67
Abnormal connection between the arterial and venous vessels is called
AV malformation
68
What causes blood to be routed directly from the artery into the vein in order to increase blood flow through the veins (AV malformation/fistula)?
high pressure in the arterial system
69
The natural response for a vein under increased blood flow is to ______ (constrict/dilate).
dilate
70
AV fistulas may occur for a number of reasons, including (5)
1) blunt or penetrating trauma
2) biopsy complications
3) tumor involvement
4) nephrectomy (kidney removal)
5) idiopathic causes
71
If a tumor is found in the RVs, the _____ should be checked to identify if there is an extension beyond the RVs.
IVC
72
In a tumor-free vessel, _____ may mimic a tumor or possibly a thrombus.
reverberation artifact
73
Some metastatic tumors may appear _____ (type of echogenicity) with the surrounding blood, making them difficult to identify.
isogenic
74
The LRV may appear enlarged at the point that it crosses over the AO, before entering the IVC; this is normal unless
the entire length of the RV is enlarged
75
T or F? Although extremely rare, IVC duplication may be misintrepreted as LRV enlargement. To avoid this confusion, it is wise to
True
| follow the vessel in question to its origin
76
RV thrombosis may occur in these disorders (6)
1) nephrotic syndrome
2) renal tumors
3) renal transplants
4) trauma
5) infant dehydration
6) compression of RV secondary to tumor
77
Signs and symptoms of acute RV thrombosis (Renal Vein Clot) may include (4)
loin or flank pain
hematuria
leg swelling
proteinuria
78
With RV thrombosis, the RV is dilated at the point _____ (proximal/distal) to the occulsion.
proximal
79
With RV thrombosis, renal size generally _____ (increases/decreases) in the acute phase and a loss of normal renal structure may be identified. Doppler flow _____ (increases/decreases).
increases
| decreases
80
Thrombus generally appears as a(n) _____ (echogenicity) focus, especially in longstanding cases.
echogenic
81
In acute phases of thrombus, it may not appear _____ (echogenicity) but may appear _____ (echogenicity) to the surrounding blood.
echogenic
| isoechoic
82
T or F? Venous aneurysms are very rare.
True
83
Some possible causes of venous aneurysms are (3)
1) weakening of vessel wall by pancreatitis
2) portal HTN
3) embryonic malformations (congenital anomalies)
84
T or F? There are often symptoms associated with small aneurysms of the PVS.
False
85
Portal venous aneurysms can be recognized as _____ (echogenicity) areas in the porta hepatis. There may or may not be thrombus and also a communication with the PV can be seen.
anechoic
86
The PV drains blood from the (6)
```
small intestines
large intestines
stomach
spleen
pancreas
GB
```
87
The SMV and SV unite behind the neck of the pancreas to form the
PV
88
The portal trunk divides into 2 lobar veins. The right branch drains the _____ and the left branch receives the _____ and _____ veins that enlarge to form umbilical varices in portal HTN.
cystic vein
umbilical
paraumbilical
89
The coronary vein, which runs along the _____ curvature of the stomach, receives _____, which also enlarge in portal HTN.
lesser
| distal esophageal veins
90
A potential complication of portal vein thrombus is
bowel ischemia and perforation
91
Portal venous thrombosis goes through several stages and appearance varies with each stage. In stage 1, the thrombus is _____ (echogenicity) in the vessel lumen.
echogenic
92
In stage 2 of portal venous thrombosis, the _____ and _____ are seen.
thrombus
| small collaterals
93
In stage 3 of portal venous thrombosis, the ______ is/are seen and the ______ is not seen/identifiable (which is called ______).
large collaterals
PV
cavernomatous transformation of the PV
94
Direct signs of PV thrombosis are (6)
| as in, what is seen visually to suggest PV thrombosis
1) visualization of clot in lumen
2) clot appears echogenic
3) if acute, clot may be difficult to see
4) local buldge of the vein at clot level
5) total occlusion: no venous or doppler signals
6) partial occlusion: normal doppler but decreased flow in vein
95
The most common cause of portal HTN in the western world is
cirrhosis
96
Clinical signs and symptoms of portal HTN are (5)
1) ascites
2) gastrointestinal bleeding
3) poor renal function
4) impaired coagulation
5) recannalization
97
Under extreme pressure, the round ligament (AKA ligamentum teres) may reopen to allow the passage of blood. This is called
recannalization
98
Recannalization is most common in patients with ______ and ______.
cirrhosis
| portal HTN
99
T or F? A dilated coronary vein detected along with identification of esophageal varices is a good indicator of portal HTN. (80%-90%).
True
100
A very useful landmark for the location of recannalized veins (especially the paraumbilical vein) is the _____ vein along with esophageal varices, because it increases in size in 80-90% of cases. 20% of patients also have a patent _____ vein.
coronary vein
| umbilical vein
101
The most significant clinical consequence of portal HTN is
variceal hemorrhage
102
The term to describe the appearance of distended and engorgeed umbilical veins, which are seen radiating from the umbilicus across the abdomen to join systemic veins is
Caput Medusae
103
_____ is a sign of severe portal HTN with portal systemic shunting through the umbilical veins.
Caput Medusae
104
Portal HTN flow is _____. Which is odd because flow should be _____.
hepatofulgal
| hepatopedal
105
T or F? In portal HTN there is isolated LPV involvement. But with tumor invasion or AV fistulas, the LRV and/or RRV may be involved.
True
106
IVC thrombus is sonographically diagnosed/described as
An intraluminal filling defect that usually expands the diameter of the vessel.
107
The differential diagnosis of vascular tumor masses tends to be large because
because the similarity in echographic appearance.
108
What are the main indicators of portal HTN? (2)
esophageal varices
| dilated coronary vein
109
A collateral network may involve (5)
```
coronary vein*****
gastroesophageal vein
umbilical vein
pancreatic duodenal vein
gastrorenal and splenorenal veins
```
110
This vein is identified by locating the splenic vein in a midline sagittal view and moving the probe to the right. It is recognized as a small vessel coursing cephalad from the splenic vein near the portal splenic confluence.
coronary vein
111
What does the presence of caput medusae indicate?
posthepatic or intrahepatic portal HTN
112
How is caput medusae formed?
by the recannalization of the umbilical vein which connects with the left hepatic branch of the PV
113
When shouldn't caput medusae be observed and why?
with isolated extrahepatic PV obstruction because the obstruction would be below the origin of the umbilical vein
114
Explain recannalization.
Under extreme pressure, the round ligament (ligamentum teres) reopens to allow the passage of blood. This is common in patients with cirrhosis and portal HTN. Patients with cirrhosis experience rapid growth of scar tissue in and around the liver, often functionally obstructing nearby vessels.
115
What is the sonographic appearance of PV thrombosis?
goes through about 3 stages
1) echogenic thrombus in lumen
2) thrombus and small collaterals visible
3) large collaterals and no identifiable PV (cavernomatous transformation)
116
Leiomyosarcomas are known to mestastitize to the ______ and ______.
liver
| lungs
117
What is a rare tumor of the IVC and where does it originate?
chromaffin
| outside the adrenal gland
118
This tumor extends into the IVC and right atrium
wilms tumor
