Journal of Ultrasound in Medicine, Vol 19, Issue 3 217-222, Copyright © 2000 by American Institute of Ultrasound in Medicine
Narrowing of the upper abdominal inferior vena cava in patients with elevated intraabdominal pressure: sonographic observations
R. H. Wachsberg
New Jersey Medical School, Newark, USA. wachsbr@umdnj.edu
Focal narrowing of the upper intrahepatic inferior vena cava on computed
tomography performed in patients with elevated intraabdominal pressure has
been reported recently. The purpose of this study was to assess this
phenomenon further with gray scale and duplex Doppler sonography. Seven
patients with elevated intraabdominal pressure due to massive ascites in
whom computed tomography showed narrowing of the intrahepatic inferior vena
cava were studied. Sonography confirmed focal narrowing of the intrahepatic
inferior vena cava that persisted throughout the respiratory and cardiac
cycles. The narrowed inferior vena cava segment had a characteristic
slitlike appearance on transverse images, slightly oblique to the sagittal
plane. A focal flow jet typical of stenosis was observed in the three
patients in whom Doppler sonography technically was feasible. In three of
four patients who were able to sit or to turn into the left lateral
decubitus position, the narrowing immediately resolved after the positional
change but promptly recurred upon return to the supine position. In
patients with elevated intraabdominal pressure, focal slitlike narrowing of
the intrahepatic inferior vena cava is an anticipated finding that should
not be misinterpreted as evidence of stenosis of the inferior vena cava or
of a juxtacaval liver lesion.
