滤器致下腔静脉穿孔1例

下腔静脉(inferior vena cava,IVC)滤器(IVC filter,IVCF)已广泛应用于临床.近年来,有关IVCF并发症的报道越来越多,主要包括:IVCF移位、断裂、IVC穿孔及IVC闭塞等[1-4].为了进一步提高对滤器导致的IVC穿孔的认识,现就1例滤器导致的IVC穿孔的患者作一报道. 临床资料 患者男,67岁.因“突发腹痛4h”入院.患者4h前进食隔夜食物后出现腹痛,呈阵发性,有恶心,无呕吐,无腹泻.该患者7年前因肺栓塞在我科置入IVCF (Simon Nitinol filter,Bard,图1①).入院查体:血压124/80 mmHg,神志清,精神焦虑,腹平软,金腹部有压痛,无反跳痛,叩诊鼓音,无移动性浊音,肠鸣音4次/min.     

Computed tomography of leiomyosarcoma of the inferior vena cava

Leiomyosarcoma of the inferior vena cava is a rare lethal malignancy. The authors report the seventy-sixth case of the literature and the sixth displayed by computed tomography. CT is presently the radiological modality of choice to localize the site and extension of the tumour, but a cavogram must also be obtained since it displays, much better than CT, the collateral veins and gives a synthetic longitudinal view of the tumour.     

Computed tomography of a double inferior vena cava: the "double cava" sign.

Right-sided retroperitoneal adenopathy or right adrenal masses demonstrated by CT in cross sectional display may mimic the CT appearance of the inferior- vena cava. This finding has been recently described as the "double cava" sign. The authors report this sign in a patient who actually has a double IVC. "CT angiography" with the technique described herein, will determine that the retroperitoneal structures demonstrated by CT are indeed vessels rather than enlarged nodes or adrenal masses.     

Leiomyosarcoma of the inferior vena cava. General review apropos of a case]

The authors report a case of leiomyosarcoma (LMS) of the second segment of the inferior vena (IVC) with liver metastasis. Treatment by surgery and chemotherapy proved to be effective, as the patient is asymptomatic 8 years after the first operation. A review of the literature shows that these tumours are rare and have a slow course. The symptoms are often relatively minor and depend on the caval segment involved. The best examination for positive and topographic diagnosis remains computed tomography, but MR Imaging is promising. The prognosis remains severe (mean survival: 2 years) and surgery is the main treatment, with various techniques according to the caval segment involved.     

Multisegmental anomaly of the inferior vena cava with thrombosis of the left inferior vena cava

We present a rare case of an extensive venous thrombosis associated with a multisegmental anomaly of the inferior vena cava (IVC), double IVCs, a hypoplastic right IVC, an aneurysm arising at the distal portion of the right IVC, and a severe stenosis between the prerenal and the hepatic segments of the IVC.     

原发性下腔静脉平滑肌肉瘤1例

患者女,55岁。子宫肌瘤、子宫切除术后5年。33天前患者无明显诱因于夜间出现鲜红肉眼血尿,伴尿频、尿急,无尿痛、腰痛、发热等症状,潜血( ),蛋白≥3g/L,WBC 4~6个/Hp,抗感染治疗后血尿消失,但多次复查尿常规尿蛋白≥3g/L,肾功:Scr 151umol/L,Ccr 67.78ml/L,24h尿蛋白0·71~1.49g。腹部B超:下腔静脉中段腔内低回声灶,累及肾静脉水平以上分支,右肾静脉起始部受累,考虑栓子形成。CT平扫下腔静脉明显增粗,其内可见略低密度灶,CT值约为20~24HU,中心可见更低密度区,肝实质CT值降低,呈肝淤血改变。增强后病变呈不均匀强化,动脉期CT值约39…     

Symptomatic interrupted inferior vena cava: report of a case presenting with haematochezia

Interrupted inferior vena cava (IVC) is a rare developmental defect. IVC interruption is usually accompanied with azygos and hemiazygos continuation, and is asymptomatic. Here, we report the imaging findings of a patient with an interrupted IVC with diffuse collaterals between the infrarenal IVC and large renal veins, left gonadal, and perirectal haemorrhoidal-portal collateral veins with associated haematochezia. Depending on the haemodynamic changes, interrupted IVC may cause possible different clinical findings as presented here.     

Computerized tomography in the follow-up of inferior vena cava filters

CT was employed to evaluate IVC filters in 37 patients; most devices (25) were Greenfield filters. Filters were localized below the renal veins in 26 patients; a suprarenal position was observed in 11 cases. Filter malpositioning was shown by CT in 1 case (filter partially located in the left renal vein); migration of the device into left pulmonary artery was detected in 1 patient. IVC perforation occurred in 11 cases--in 6 of them, the filter penetrated into adjacent structures (duodenum in 2 cases, abdominal aorta in 2, liver in 1, and right kidney in 1 patient). IVC thrombosis was seen in 16 patients; complete caval obstruction developed in 2 cases two or more years after filter positioning. IVC perforation caused by a filter is a frequent complication (30% of our series), but in most cases it is asymptomatic and has no significant clinical relevance; surgical removal of the filter had to be performed in 3 cases only. CT scanning is a valuable adjunct to plain abdominal radiography in the follow-up of IVC devices, when a complication (especially IVC perforation) is suspected.     

Leiomyosarcoma of the inferior vena cava: Angiographic and computed tomography findings

Leiomyosarcoma, a highly malignant tumor of the inferior vena cava, is rare. Only 55 cases have been reported in the world literature, and of these only 18 were evaluated with a special vascular procedure, either arteriography or inferior vena cavography. In two cases of leiomyosarcoma of the inferior vena cava, we performed arteriography and inferior vena cavography. In one, computed tomographic studies were also carried out. Cavography showed a lobulated filling defect in one case and complete caval occlusion with collateral circulation in the other. In the one case in which it was performed, computed tomography clearly demonstrated the tumor's size and its relationship to surrounding organs. Arteriographic studies, however, allowed only an indistinct delineation of the extent of tumor growth in one case. Venography followed by computed tomography should permit adequate assessment of most leiomyosarcomas of the inferior vena cava, with arteriography reserved for tumors involving the upper cava in which hepatic involvement must be evaluated.     

双下腔静脉伴左下腔静脉汇合半奇静脉及右肾静脉瘤1例

患者,女,33岁。因突发右腹部疼痛1天来我院就诊。B超提示右侧肾盂旁血管异常,临床怀疑主动脉夹层行胸腹主动脉CTA检查。     

Polysplenia with duplication of the inferior vena cava. Apropos of a case

A case of polysplenia fortuitously discovered in an adult by sonography, then studied by computed tomography and inferior vena cavography, is reported. In the absence of cardiac anomalies, the different elements of the syndrome are discussed: multiple spleens, abdominal heterotaxia and vascular malformations. The duplication of the inferior vena cava is exceptional in this disease. Its original characteristic is shown by the cavography and brought to its embryologic origin.     

Translumbar high inferior vena cava access placement in patients with thrombosed inferior vena cava filters

Venous access is a dire necessity in some patients such as those with end-stage renal disease or short gut syndrome. The right internal jugular vein is the preferred entry site for tunneled central venous catheters. Alternatively, the left internal jugular is considered next, with the external jugular and subclavian veins being considered later. Catheter-related venous stenosis approaches 40% in certain sites, resulting in loss of access sites. As sites are lost, insertion of functional long-term central venous catheters becomes challenging. Translumbar inferior vena cava (IVC) access created in two patients with limited venous access sites who had thrombosed IVCs containing IVC filters is described. Because of the higher IVC punctures in these cases, procedural planning with cross-sectional imaging is crucial to avoid puncturing the right renal artery as it passes posterior to the IVC.     

Detection of inferior vena cava abnormalities by computed tomography.

The diagnostically useful computed tomography (CT) findings in five new cases of inferior vena cava thrombosis are reported. These findings include: (a) inhomogeneous density of the inferior vena cava, usually best demonstrated after contrast medium injection; (b) caval density less than aortic density; (c) rim enhancement which may be seen with both caval thrombosis and tumor invasion; and (d) enlargement of the vena cava if accompanied by at least one or more of the above findings. A bolus injection of contrast medium followed immediately by CT helps to make some of the above described findings more prominent. In selected patients, this injection should be made into the femoral vein.     

Anomalous inferior vena cava associated with horseshoe kidney on multidetector computed tomography

We evaluated the prevalence of anomalous inferior vena cava (IVC) associated with 205 patients with horseshoe kidney (HSK) and 1990 patients without HSK on multidetector computed tomography and compared prevalence between both groups. We identified anatomical variations of the IVC in 8 patients (3.9%) with HSK (1 preisthmic IVC with retrocaval ureter, 4 double IVCs, 2 left IVCs, and 1 IVC with azygos continuation) and in 12 patients (0.6%) without HSK (8 double IVCs, 3 left IVCs, and 1 IVC with azygos continuation). Anomalous IVC was significantly more frequent in patients with HSK than those without it.     

Percutaneous translumbar inferior vena cava cannulation under computed tomography guidance

Percutaneous translumbar inferior vena cava (IVC) cannulation is an alternative approach for central venous catheterization, but there have been sporadic reports of puncture-related complications. To avoid complications during IVC puncture, percutaneous translumbar IVC cannulation was performed under computed tomography (CT) guidance in addition to fluoroscopy in two patients. To perform chemotherapy for recurrent breast cancer, we planned subcutaneous port catheter placement for central venous access. Under CT guidance, the direction and insertion distance of a long elastor needle were adjusted, and the IVC was punctured at the level of the third lumbar vertebra while taking care to avoid the right urinary tract. A guidewire was inserted through the long elastor needle, and a catheter was placed over the guidewire. It was possible to perform central venous catheterization by percutaneous translumbar inferior vena cava cannulation under CT guidance.     

Calcified thrombus of the inferior vena cava. Apropos of a case

A case of calcified thrombus in the inferior vena cava discovered in child during the screening of a scoliosis is presented. Standard X-rays demonstrate the calcification and allow the diagnosis of calcified thrombus. Ultrasound, if necessary, can be performed. Pathogenesis remains at the present time unknown but congenital or hemodynamic factor are probable. Children are asymptomatic and no specific treatment is advised.