IVC: Sonographic evaluation and disease

Question 1

Aorta

Answer 1

Not affected by valsalva
Does not touch liver
Thicker, more echogenic walls. 
Cardiac Pulsatility
Multiple anterior branches
No vessels posterior.

Question 2

IVC

Answer 2

Diameter changes with valsalva
Touches liver
Thin walls
Respiratory phasicity
Hepatics only anterior branches
RRA posterior to IVC

Question 3

IVC Doppler

Answer 3

Note the respiratory phasicity and cardiac pulsatlitiy of the IVC flow. These are normal venous flow characteristics for the IVC and Hepatic veins. Cardiac pulsatility is not normally identified in the lower extremity veins.

Question 4

Dilated IVC

Answer 4

Congestive heart failure and pulmonary hypertension are common causes for IVC dilation without respiratory phasicity.
There is no change in the IVC diameter with respiration

Question 5

IVC thormbus

Answer 5

Thrombus formation in the IVC carries an extreme risk for pulmonary embolism.

Question 6

Hepatic Veins

Answer 6

The color image demonstrates the bunny sign with the IVC, left and middle hepatic veins. the PW doppler tracing demonstrates normal respiratory phasicity and cardiac pulsatility.

Question 7

RT hepatic vein

Answer 7

RT hepatic vein should be evaluated with doppler in the long view. The course of vein causes an off axis evaluation when assessed in the trans veiw. Note the position of the doppler cursor related to the venous flow direction. The best Doppler tracing is obtained with the Doppler cursor placement as close to parallel to the flow as possible.

Question 8

LT and Middle hepatic veins

Answer 8

LT and middle hepatic vein are best evaluated with Doppler from a transverse view of the abdomen. The right hepatic vein should be evaluated with Doppler in the long view. The course of the vein causes an off axis evaluation when assessed in the transverse view.