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Clinical Relevance of Retrograde Inferior Vena Cava or Hepatic Vein Opacification During Contrast-Enhanced CT

Benjamin M. Yeh1, Philip Kurzman1,2, Elyse Foster3, Aliya Qayyum1, Bonnie Joe1 and Fergus Coakley1

1 Department of Radiology, University of California-San Francisco, 521 Parnassus Ave., Rm. C-324C, Box 0628, San Francisco, CA 94143-0628.
2 Present address: Department of Radiology, University of Chicago Hospitals, Chicago, IL.
3 Department of Medicine, University of California-San Francisco, San Francisco, CA.



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  		Fig. 1A. —35-year-old woman with shortness of breath. Echocardiography showed no evidence of right-sided heart disease. CT scan of chest obtained with high rate of IV contrast injection to evaluate for possible pulmonary embolus shows retrograde opacification of inferior vena cava and hepatic veins (arrows).

 


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  		Fig. 1B. —35-year-old woman with shortness of breath. Echocardiography showed no evidence of right-sided heart disease. CT scan of chest obtained at more caudal level shows little opacification of right and middle hepatic veins branches (arrowheads).

 


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  		Fig. 2. —Boxplots of vein diameters on CT in patients with and without right-sided heart disease at echocardiography. Horizontal line through each box represents median diameter. Top and bottom of each box represent interquartile ranges (75% and 25%). Whiskers mark 95% range; circles indicate outliers. Mean diameter of each vessel in this graph, except for that of suprahepatic inferior vena cava in CT examinations with low injection rate, was significantly larger when right-sided heart disease was found (dotted lines) at echocardiography than when it was not (solid lines) (p < 0.05 for each). However, extensive overlap is seen between vessel diameters in patients with and without right-sided heart disease. IVC = inferior vena cava.

 

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