Sonographic evaluation of inferior vena caval obstruction: correlative study with vena cavography

Sonographic findings of obstruction of the inferior vena cava (IVC) in 14 cases are described and correlated with venographic findings. The causes of the obstruction were membrane (five cases), thrombosis (three), and intraluminal tumor invasion by hypernephroma, hepatoma, and adrenal carcinoma in six. Sonographic examination revealed highly echogenic segmental obliteration or membrane in membranous obstruction and echogenic intraluminal mass in thrombotic occlusion. Absence of an identifiable patent lumen in a technically satisfactory study was another finding in thrombotic obstruction. On real-time sonograms, the normal respiratory changes of the IVC were absent when there was complete occlusion. Transhepatic collaterals, patency of other segments of the IVC, and associated malignancy were additional sonographic findings. Comparison to venography suggested that in addition to ease and safety, sonography has advantages in delineation of the cephalad extent of occlusion, dynamic evaluation of the IVC below the obstruction, and the simultaneous evaluation of adjacent organs.