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Inferior Vena Cava Filling Defects on CT and MRI

Department of Radiology, University of California San Francisco, Box 0628, C-324C, 505 Parnassus Ave., San Francisco, CA 94143-0628.

View larger version (154K): [in a new window]   Fig. 1A —64-year-old man with incidental CT finding of pseudothrombus caused by opacified blood from renal veins streaming into unopacified inferior vena cava (IVC). Axial enhanced CT image shows filling defect (arrow) caused by inflow of opacified blood from renal veins mixing with poorly opacified blood in IVC.

View larger version (100K): [in a new window]   Fig. 1B —64-year-old man with incidental CT finding of pseudothrombus caused by opacified blood from renal veins streaming into unopacified inferior vena cava (IVC). Curved multiplanar image reveals opacified blood from renal veins streaming into IVC (arrows). This case illustrates how axial image can show IVC filling defect.

View larger version (156K): [in a new window]   Fig. 2A —54-year-old man with pseudothrombus in intrahepatic inferior vena cava (IVC) resulting from flow artifact. Axial enhanced CT image obtained in portal venous phase shows filling defect (arrow) in intrahepatic IVC.

View larger version (160K): [in a new window]   Fig. 2B —54-year-old man with pseudothrombus in intrahepatic inferior vena cava (IVC) resulting from flow artifact. Axial enhanced CT image, delayed venous phase, reveals accessory right hepatic vein inflow (arrow) that accounts for filling defect seen on earlier phase images.

View larger version (151K): [in a new window]   Fig. 3 —78-year-old man with pseudothrombus in inferior vena cava (IVC) caused by high contrast-injection rate. Axial enhanced CT image, early arterial phase, shows IVC filling defect (arrowhead) due to laminar flow of refluxed contrast from hepatic veins. Bright enhancement in hepatic veins (arrows) is seen because of reflux of contrast from heart.

View larger version (155K): [in a new window]   Fig. 4A —50-year-old woman with renal cell carcinoma and acquired cystic kidney disease. Axial enhanced CT image shows heterogenous enhancement of inferior vena cava (IVC) (arrow), suggesting tumor invasion.

View larger version (151K): [in a new window]   Fig. 4B —50-year-old woman with renal cell carcinoma and acquired cystic kidney disease. Axial gadolinium-enhanced T1-weighted MR image shows filling defect (arrow) of intrahepatic IVC, also suggesting tumor invasion.

View larger version (138K): [in a new window]   Fig. 4C —50-year-old woman with renal cell carcinoma and acquired cystic kidney disease. Axial steady-state gradient-echo flow-sensitive MR image shows patency of IVC (arrow) and absence of true filling defect. Low venous return from failed kidneys may have contributed to apparent intracaval defect.

View larger version (91K): [in a new window]   Fig. 5A —73-year-old man with incidental CT finding of pseudolipoma. Axial enhanced CT image shows apparent inferior vena cava filling defect (arrow) of fat density.

View larger version (153K): [in a new window]   Fig. 5B —73-year-old man with incidental CT finding of pseudolipoma. Coronal T2-weighted MR image shows shelf of pericaval fat (arrow) above caudate lobe. Fat collection may appear intraluminal on axial images.

View larger version (139K): [in a new window]   Fig. 6A —50-year-old man with bland thrombus in inferior vena cava (IVC) and left renal vein that extends proximally after filter placement. Axial enhanced CT image before IVC filter placement shows bland thrombus (arrow) in IVC.

View larger version (154K): [in a new window]   Fig. 6B —50-year-old man with bland thrombus in inferior vena cava (IVC) and left renal vein that extends proximally after filter placement. Coronal multiplanar image reconstructed from CT data after IVC filter placement shows extension of bland thrombus into both renal veins (arrowheads) and intrahepatic IVC. Note IVC filter (arrow) and decreased enhancement of right kidney due to hypoperfusion.

View larger version (157K): [in a new window]   Fig. 7 —36-year-old man with previously removed IV catheter. Axial enhanced CT image shows circular filling defect (arrows) within infrahepatic inferior vena cava consistent with fibrin sheath.

View larger version (122K): [in a new window]   Fig. 8A —45-year-old woman with uterine leiomyomatosis. Axial enhanced CT image obtained at level of pelvis shows heterogenous hyper-enhancing lesion (arrowheads) in uterus consistent with uterine leiomyoma.

View larger version (99K): [in a new window]   Fig. 8B —45-year-old woman with uterine leiomyomatosis. Axial enhanced CT image obtained below inferior vena cava (IVC) bifurcation shows IV leiomyomatosis (arrow) within right common iliac vein.

View larger version (122K): [in a new window]   Fig. 8C —45-year-old woman with uterine leiomyomatosis. Axial enhanced CT image obtained at level of gallbladder reveals filling defect (arrow) of IVC due to cephalad extension of IV leiomyomatosis.

View larger version (136K): [in a new window]   Fig. 9 —66-year-old woman with adrenocortical carcinoma. Coronal T2-weighted MR image shows large adrenal mass (arrowheads) with tumor thrombus extending into infrahepatic inferior vena cava (arrow).

View larger version (100K): [in a new window]   Fig. 10A —46-year-old woman with metastatic colon carcinoma to lung. Axial steady-state gradient-echo flow-sensitive MR image shows direct extension of lung mass (arrowheads) into inferior vena cava (IVC) (arrow).

View larger version (132K): [in a new window]   Fig. 10B —46-year-old woman with metastatic colon carcinoma to lung. Coronal T1-weighted MR image shows lung metastasis (white arrow) invading supradiaphragmatic IVC (black arrow) and another metastasis (arrowheads) invading right pulmonary artery.

View larger version (122K): [in a new window]   Fig. 11A —47-year-old man with hepatocellular carcinoma. Axial enhanced CT image, early arterial phase, shows hypervascular hepatocellular carcinoma (arrows) in liver.

View larger version (103K): [in a new window]   Fig. 11B —47-year-old man with hepatocellular carcinoma. Axial enhanced CT image obtained at higher level than A reveals similarly enhancing tumor thrombus (arrow) in inferior vena cava.

View larger version (143K): [in a new window]   Fig. 12A —46-year-old man with renal cell carcinoma. Axial unenhanced T1-weighted MR image shows tumor thrombus (arrowheads) extending into right renal vein, abutting bland thrombus (arrow) of higher signal intensity in inferior vena cava (IVC). Note large lesion (asterisk) in upper pole of right kidney consistent with renal cell carcinoma.

View larger version (165K): [in a new window]   Fig. 12B —46-year-old man with renal cell carcinoma. Axial gadolinium-enhanced T1-weighted MR image shows enhancing renal mass with tumor thrombus (arrowheads) extending into right renal vein adjacent to non-enhancing bland thrombus in IVC (arrow).

View larger version (138K): [in a new window]   Fig. 12C —46-year-old man with renal cell carcinoma. Coronal unenhanced T1-weighted MR image reveals bland thrombus (arrowheads) that formed inferior in relation to tumor thrombus (arrows) seen in infrahepatic IVC. Lesion of low signal intensity is present in right kidney (asterisk), representing renal cell carcinoma.

View larger version (181K): [in a new window]   Fig. 13A —66-year-old woman with leiomyosarcoma arising in inferior vena cava (IVC). Axial enhanced CT image obtained at level of pancreas shows heterogeneously enhancing mass (arrow) in IVC.

View larger version (136K): [in a new window]   Fig. 13B —66-year-old woman with leiomyosarcoma arising in inferior vena cava (IVC). Pathologic specimen of leiomyosarcoma in IVC.

View larger version (140K): [in a new window]   Fig. 14 —47-year-old man with Budd-Chiari syndrome 1 year after nephrectomy was performed for right-sided renal cell carcinoma. Axial enhanced CT image shows tumor thrombus in inferior vena cava lumen (large arrow) and adjacent surgical clips (small arrow) from previous nephrectomy. Heterogenous enhancement of liver and ascites (arrowheads) is seen, consistent with hepatic outflow obstruction.

View larger version (144K): [in a new window]   Fig. 15A —54-year-old woman with renal cell carcinoma invading inferior vena cava (IVC) and pulmonary emboli. Axial T2-weighted MR image with fat saturation shows right-sided renal mass (arrowheads) with heterogeneous high signal consistent with renal cell carcinoma. Tumor thrombus is present in adjacent IVC (arrow).

View larger version (123K): [in a new window]   Fig. 15B —54-year-old woman with renal cell carcinoma invading inferior vena cava (IVC) and pulmonary emboli. Axial T1-weighted MR image reveals large IVC tumor thrombus (arrows).

View larger version (98K): [in a new window]   Fig. 15C —54-year-old woman with renal cell carcinoma invading inferior vena cava (IVC) and pulmonary emboli. Axial enhanced CT image shows large thrombus in right main pulmonary artery (arrowheads) and left lower lobe pulmonary artery (arrow).

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