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Inferior Vena Cava

  • Alaa M. Omar
  • Edgar Argulian
  • Jagat Narula
Chapter

Abstract

Venous blood is derived back to the right side of the heart from the lower part of the body through the inferior vena cava (IVC). The IVC opens into the lowest part of the right atrium (RA) directed upward and backward by a rudimentary valve (Eustachian valve) at the level of the lower third of the ninth thoracic vertebra. The IVC is usually visualized and assessed by echocardiography using the subcostal approach. Respiratory changes and collapsibility of the IVC can be effectively used for the assessment of the right sided pressures and intravascular volume status [1–3]. IVC measurements can be done on the 2D- or M-mode recording of the IVC during at least one whole respiratory cycle. The recording should start from end expiration and involves inspiratory effort “sniff” followed by return to expiration again [1, 3]. IVC measurements should be done 2 cm away from the RA inlet [4]. IVC visualization can also help in assessment of several anatomical obstruction conditions such as IVC stenosis, thrombosis, and masses, in addition to several congenital abnormalities.

Keywords

Point-of-care cardiac ultrasound Inferior vena cava Right atrial pressure Volume status 

Supplementary material

Video 22.1

IVC visualization using anterior axillary approach. This view uses the liver as an acoustic window. With the patient in supine position, the probe is placed in the right anterior axillary line with acoustic marker pointing toward the patient’s head. From this approach, the IVC can be seen crossing the diaphragmatic opening longitudinally adjacent to the liver and parallel to the aorta. Visualizing the IVC entering the RA confirms its identity and differentiates it from the aorta. See Fig. 22.3. Video courtesy of Piedad Lerena Saenz, MD (MOV 570 kb)

Video 22.2a

Echocardiographic assessment of the aorta for differentiation from IVC. In comparison to the IVC, the aorta is an incompressible thick-wall vessel that does not change its diameter with respiration, and Doppler velocity signals are of high velocities. See Fig. 22.4. Video courtesy of Alaa M. Omar, MD, PhD (MOV 1983 kb)

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Video 22.2b Another view of echocardiographic assessment of the aorta for differentiation from IVC. Video courtesy of Alaa M. Omar, MD, PhD (MOV 315 kb)
Video 22.2c

Another view of echocardiographic assessment of the aorta for differentiation from IVC. Video courtesy of Alaa M. Omar, MD, PhD (MOV 1539 kb)

Video 22.3

2D echocardiographic assessment of IVC showing normal inspiratory collapse. See Fig. 22.6. Video courtesy of Alaa M. Omar, MD, PhD (MOV 1100 kb)

Video 22.4

IVC plethora in a patient with pulmonary hypertension . The IVC is engorged and does not demonstrate normal inspiratory collapse. These findings suggest elevated right atrial pressures. See Fig. 22.9. Video courtesy of Alaa M. Omar, MD, PhD (MOV 1318 kb)

Video 22.5

Loss of IVC collapse in a patient with constrictive pericarditis. The IVC is assessed at end-expiration and with inspiration (sniff). These phases can be confirmed in the image using a respirometer for recording of the respiratory movements. See Fig. 22.10. Video courtesy of Alaa M. Omar, MD, PhD (MOV 789 kb)

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Video 22.6a Renal cell carcinoma extending to the IVC and the RA. See Fig. 22.11. Video courtesy of Piedad Lerena Saenz, MD (MOV 509 kb)
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Video 22.6b Another view of renal cell carcinoma extending to the IVC and the RA. See Fig. 22.11. Video courtesy of Piedad Lerena Saenz, MD (MOV 482 kb)
Video 22.7a

IVC stenosis. Focal narrowing of the IVC just before its opening into the RA. See Fig. 22.12. Video courtesy of Piedad Lerena Saenz, MD (MOV 2312 kb)

Video 22.7b

IVC stenosis. Color flow Doppler showing turbulence and acceleration of the blood flow with a convergence zone developing at the stenotic end. See Fig. 22.12. Video courtesy of Piedad Lerena Saenz, MD (MOV 998 kb)

Video 22.8

Budd Chiari syndrome. Thrombosis developed at the middle hepatic vein as it joins the IVC. The thrombosis extends to the IVC, with color flow Doppler showing significant flow impingement. See Fig. 22.13. Video courtesy of Piedad Lerena Saenz, MD (MOV 989 kb)

References

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Alaa M. Omar
    • 1
    • 2
    • 3
  • Edgar Argulian
    • 4
  • Jagat Narula
    • 5
  1. 1.Department of CardiologyIcahn School of Medicine at Mount SinaiNew YorkUSA
  2. 2.Department of Internal MedicineBronx Lebanon Hospital CenterBronxUSA
  3. 3.Department of Internal MedicineNational Research CenterCairoEgypt
  4. 4.Mount Sinai St. Luke’s Hospital, Icahn School of Medicine at Mount SinaiNew YorkUSA
  5. 5.Mount Sinai Hospital, Icahn School of Medicine at Mount SinaiNew YorkUSA

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