1. enlarged liver

2. para-aortic lymph node enlargement

3. retroperitoneal masses or tumors

4. pancreatic tumors

5. a congential IVC valve may also obstruct the lumen of the IVC

1. Abdominal pain

2. Ascites

3. Tender hepatomegaly

4. Lower extremity edema may also be present in the most severe forms of IVC blockage

If the fragment migrates to adjacent tissues

-Asymptomatic patient: no treatment necessary

- Symptomatic Patient: confirm location with CT scan and consider surgical removal if feasible. If fracture results incompromise of filter function: place a second filter

Primary

Metastatic

an extension from a primary

These type of tumors tend to develop in women, the median age of detection is 61 years

With leiomyosarcomas metastasis to the iver and lungs have been reported

Renal carcinoma

secreting and non-secreting adrenal tumors

retroperitoneal sarcomas

hepatocellular carcinomas

teratomas

lymphomas

- Primary vascular neolasm

- maignant IVC mass

- chronic thrombus

- larger primary tumors outside the vessel

The presence of a primary tumor and its site

The cranial extent of the tumor mass

Possible tumor involvement or invasion of the wall of the vessel

True or False

Primary tumors of the IVC tend to be a very common finding

False

Primary tumors of the IVC, most of which are leiomyomas or leiomyosarcomas, tend to be uncommon with a vascular incidence of only 2%

renal carcinoma (most common)

secreting and non secreting adrenal tumors

retroperitoneal sarcomas

hepatocellular carinoma

teratomas

lymphomas

1) Does it involve the hepatic veins or the right atrium

2) Is there tumor involvement or invasion of the wall of the vessel

- Increased flow due to a splenorenal or gastrorenal shunt in patients

- with portal HTN or portal thrombosis

- Tumor involvement from renal cell carcinoma

- Increased flow from an AV malformation in the kidney

- Symptoms in the presence of an enlarged renal vein are generally associated with the initial disease process and are not the resul of the venous enlargement.

- Tumor involvement of the renal veins usually produces no specific symptoms that would lead to suspicion of tumor extension

may indicated tumor involvement

portal venous HTN

with renal vein collateral anastomosis

AV fistula

Blunt or penetrating trauma

biopsy complications

tumor involvement

nephrectomy

idiopathic causes

distrubed or turbulent venous flow signals are evident in the enlarged renal vein

Velocities may also be abnormally rapid

In a tumore free vessel, reverberation arifact may mimic a tumor or possible a thrombus

It is also possible that some metastatic tumors may appear isoechoic with the surrounding blood, making them very difficult to identify

The left renal vein may appear enlarged at the point where it crosses over the aorta before entering the IVC. This is a normal finding in may persons. Dilatation should be suspected only if the entire length of the renal vein is enlarged

Nephrotic syndrome

renal tumors

renal transplants

trauma

infant dehydration

compression of the renal vein secondary to tumor

loin or flank pain

hematuria

leg swelling

proteinuria

renal size generally increases in the acute phase and a loss of normal renal structure may be identified

doppler flow decreases

Thrombus generally appears as an echogenic focus, especially in longstanding cases

In more acute phases, thrombus may not appear echogenic but isoechoic to the surrounding blood (The staging of a blood clot)

Weakening of the vessel wall by pancreatitis

portal HTN

embryonic malformations (congenital anomalies)

Portal venous aneurysms can be recognized as anechoic areas in the porta hepatis. There may or may not be thrombus and a communicaion with the portal vein can be seen

doppler can be used to verify the venous nature of the echo free structure by detecting a turbulent venous signal in the lesion

other venous aneurysms are rare but they all resemble a portal vein aneurysm sonographically

Portal HTN

inflammatory adb process like appendicitis, peritonitis, pancreatitis

Trauma

Postsurgical complications

Hypercoagulability states

abd neoplasms

renal transplant

benign ulcer disease

idiopathic

Abd Pain

Low grade fever

Leukocytosis

Hypovolemia

shock

abdominal rigidity

elevated liver function tests

N & V

Hematemesis

Melena

It goes through several stages and the appearance varies with each stage-

1. echogenic trhombus in vessel lumen

2. thrombus and small collaterals

3. large colaterals and no identifiable portal vein (cavernomatous transformation of the portal vein

- Visualization of a clost in the lumen

- clot appears echogenic

- if acute, clot may be difficult to identify

- local bulge of the vein at clot level

- total occlusion: no venous doppler signals

- Partial occlusion: normal doppler but decreased flow in vein

No portal vein landmarks

collateral vessel formation

increased SMV and splenic vein caliber

What is formed in an effort to relieve the pressure from PHTN and what do they connect to?

What is it called?

Where does these varicose veins occur?

What happens if these varicose veins rupture?

most frequently occurs in the area of the esophagus, stomach, and rectum

If these varicose veins rupture it may cause massive bleeding that may result in death

ascites

GI bleeding

Poor renal function

impaired coagulation

recannalization

Portal vein may be enlarged, but it may be normal or small due to develoment of collaterals

Look for secondary effect of increased pressure within the venous system like collateral channel development or renanalization and abnormal respiratory responses

coronary vein

gastroesophageal vein

umbilical vein

pancreatic duodenal vein

gastrorenal and splenorenal veins

Ascites

GI Bleeding

Poor renal function

Impaired coagulation