The etiology of inferior vena caval obstruction and compression

This review of inferior vena caval obstruction and narrowing centers the discussion on the major groups of diseases which produce primary or secondary obstruction and those which cause distortion or narrowing of the inferior vena cava. Although the majority of these diseases which are involved affect both adults and children, a separate discussion of pediatric causes of inferior vena caval involvement is included. The paper has been organized for discussion by the anatomic areas of potential involvement by disease: the lower, middle, and upper thirds of the vena cava. Other subjects which are covered include a description of the various techniques used for performing inferior vena cavography. A section on the normal anatomy, anatomic variations which may be encountered, and collateral venous pathways is presented. There is also a section on possible pitfalls in interpretation of cavography. The relative value of the vena cavogram in the evaluation of abdominal disease is discussed and the cavogram is compared with other methods of evaluating the retroperitoneum such as arteriography, lymphangiography, excretory urography, and B-mode ultrasonography. Numerous illustrations are included to demonstrate various aspects of inferior vena caval involvement by diseases. Where appropriate, short discussions of the clinical aspects are also included.