Inferior vena cava obstruction and diffuse hepatic uptake on lower extremity radionuclide venogram

Two patients with dissimilar but advanced malignancies and lower extremity swelling underwent bilateral lower extremity radionuclide venograms, several months apart. Both patients' scintigrams showed multiple collaterals in the abdomen and pelvis, consistent with inferior vena cava obstruction, and hepatic uptake in a diffuse pattern. One patient also had multiple bilateral pulmonary emboli on a lung scan. Although diffuse hepatic uptake has been mentioned before with inferior vena cava obstruction, it has usually been incidental to focal hepatic uptake near the porta hepatis. The case results in this study demonstrated that inferior vena cava obstruction can manifest itself solely as diffuse hepatic uptake on nuclear venograms. The authors believe that either pattern can be corroborative of inferior vena cava obstruction on a nuclear venogram.