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Updated: Jul 4, 2026

Image Acquisition Method for the Sonographic Assessment of the Inferior Vena Cava
Published on: January 13, 2023
Evaluating inferior vena cava reflux and RV/LV ratio as predictors of acute pulmonary thromboembolism severity
Ehsan Goudarzi1,2, Diba Akbarzadeh3, Saba Aghajani1
1Department of Medicine, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Purpose:
This study aimed to evaluate the predictive value of inferior vena cava (IVC) reflux and the right ventricle to left ventricle ratio (RV/LV ratio) in risk stratification of acute pulmonary thromboembolism (APTE) patients.
Methods:
In this retrospective, cross-sectional study, eighty-six patients diagnosed with APTE underwent computed tomography pulmonary angiography (CTPA). The pulmonary arterial obstruction index (Qanadli score) was evaluated by an experienced radiologist, along with the RV/LV ratio and IVC reflux grading (1-6) based on CTPA. Correlations between the Qanadli score, IVC reflux grade, and RV/LV ratio were analyzed. Linear regression was performed after confirming regression assumptions. Additionally, IVC reflux grade and Qanadli score were compared between patients with RV/LV ratios below and above 0.9.
Results:
The mean Qanadli score was 7.20 ± 8.04. A significant correlation was found between the Qanadli score and IVC reflux grade (r = 0.601, p < 0.001), whereas no significant correlation was observed between the Qanadli score and RV/LV ratio (r = 0.131, p = 0.230). Further analysis demonstrated a significant linear association between the Qanadli score and IVC reflux grade, with a regression coefficient of 3.98 ± 0.55 (p < 0.001) and an adjusted R² of 0.38. However, patients with an RV/LV ratio > 0.9 did not show a significant difference in IVC reflux grade (p = 0.176) or Qanadli score (p = 0.439).
Conclusion:
Our study highlights IVC reflux as a potential valuable imaging marker for assessing APTE severity, while also pointing out the limitations of relying solely on the RV/LV ratio for risk stratification.
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Jugular Venous Pressure (JVP) Measurement
Position the patient at a thirty- to forty-five-degree angle or in a semi-fowler's position. Look for the highest point of pulsation in the internal jugular vein and measure the vertical distance to the angle of Loius or sternal angle. A normal JVP is 3-4 cm above the...
