📄 SCRS
Inferior vena cava (IVC) thrombosis
Inferior vena cava (IVC) thrombosis ultrasound case study
USG
Inferior vena cava (IVC) thrombosis ultrasound case study
CASE–1
Inferior Vena Cava (IVC) Thrombus
Inferior Vena Cava (IVC) Thrombus
Clinical History
A 56-year-old male presented with bilateral lower limb swelling and dull abdominal discomfort. There was no history of recent trauma. Ultrasound with Color Doppler examination of the abdomen was performed to evaluate the inferior vena cava for suspected venous thrombosis.
Ultrasound Findings
Ultrasound examination demonstrates an echogenic intraluminal filling defect within the inferior vena cava (IVC), consistent with IVC thrombus. The involved segment of the IVC is mildly distended and demonstrates partial absence of color Doppler flow around the thrombus with markedly reduced venous flow on spectral Doppler. The thrombus appears adherent to the vessel wall without evidence of internal vascularity. No extension into the hepatic veins or right atrium is identified on the current examination. The abdominal aorta appears normal.
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| Abdominal vascular ultrasound. Longitudinal Color Doppler sonographic image demonstrates an echogenic thrombus within the inferior vena cava (IVC) producing a partial intraluminal filling defect with reduced Color Doppler flow, consistent with IVC thrombosis. |
Report Line
An echogenic intraluminal thrombus is identified within the inferior vena cava (IVC), producing partial luminal obstruction with markedly reduced Color Doppler flow. No internal vascularity is demonstrated within the thrombus. No sonographic evidence of extension into the hepatic veins or right atrium is identified on the current examination.
Impression
Inferior vena cava (IVC) thrombosis with partial luminal obstruction.
No sonographic evidence of thrombus extension into the hepatic veins or right atrium.
Go To Table
No sonographic evidence of thrombus extension into the hepatic veins or right atrium.
Recommendation
Correlate with the patient's clinical presentation and coagulation profile. Contrast-enhanced CT or MR venography may be performed to determine the full extent of thrombosis and evaluate for an underlying cause such as malignancy or venous compression. Prompt vascular medicine or vascular surgery consultation is recommended for anticoagulation and further management. Assessment for lower extremity deep vein thrombosis and pulmonary embolism should also be considered when clinically indicated.
Key Learning Points
- IVC thrombosis appears as an echogenic intraluminal filling defect with partial or complete absence of Color Doppler flow.
- The affected IVC may appear dilated and non-compressible, although direct compression is often limited because of its retroperitoneal location.
- Color and spectral Doppler demonstrate reduced or absent venous flow depending on the degree of obstruction.
- Ultrasound should evaluate for extension into the iliac veins, renal veins, hepatic veins, and right atrium.
- Common causes include deep vein thrombosis extension, malignancy, hypercoagulable states, pregnancy, trauma, and indwelling IVC filters or catheters.
- CT or MR venography is useful for defining the extent of thrombus and identifying the underlying etiology.
- Differential diagnoses include tumor thrombus (especially renal cell carcinoma), bland thrombus, congenital IVC anomalies, and flow-related Doppler artifacts.
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