How is inferior vena caval thrombosis diagnosed?

Updated: Jun 12, 2018
  • Author: Luis G Fernandez, MD, FACS, FASAS, FCCP, FCCM, FICS, KHS, KCOEG; Chief Editor: John Geibel, MD, DSc, MSc, AGAF  more...
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No specific laboratory test includes or excludes the diagnosis of inferior vena cava (IVC) thrombosis (IVCT), though evaluation of the clotting and fibrinolytic systems and assessment of the thrombin antagonists may be helpful.

The ideal imaging modality to help diagnose an IVC anomaly must have high diagnostic accuracy and also be safe and reproducible. It is difficult to establish a diagnosis of any IVC anomaly by means of ultrasonography (US). However, various clues are recognized on radiologic imaging that could help diagnose an absent IVC or anomaly.

One of the more common and helpful clues is well-developed and possibly dilated intrathoracic hemiazygos or azygos continuations. These collateral circulations, as well as other retroperitoneal venous pathways, are usually well developed before symptoms present. [29] However, plain radiography should not be used as a primary diagnostic tool.

The most reliable noninvasive methods for establishing a diagnosis of IVC anomalies are computed tomography (CT) with intravenous (IV) contrast and magnetic resonance imaging (MRI). CT, unlike US, is a good imaging modality for the retroperitoneal space. [30] Another accurate, albeit more invasive, imaging modality is venography, which is particularly useful if any surgery is planned.

Although other modalities may have a more primary role, IVCT may still be diagnosed intraoperatively in patients who were treated with laparotomy for their primary problem.

IVCT remains a challenging process to diagnose and treat. Opinions differ among critical care physicians, surgeons, radiologists, and other physicians regarding the optimal diagnostic study for this condition.Technologic advances in US, endovascular US (EVUS), CT, and MRI, as well as endovascular procedures, have increased the detection rates of vena cava anomalies and venous thrombosis. [31]  Bilateral lower-limb venous duplex US coupled with MRI is an optimal noninvasive approach in most patients. [32]  However, the current general consensus is that contrast venography remains the criterion standard.

Go to Deep Venous Thrombosis for more complete information on this topic.

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