Chapter 26: The Inferior Vena Cava and Iliac Veins

Question 1

the union of two or more veins to form a larger vein; the equivalent of a bifurcation in the arterial system

Answer 1

confluence

Question 2

a typically cone shaped medical device designed to prevent pulmonary embolism; it is placed into the inferior vena cava so that it can trap venous thromboemboli for the lower extremities before they travel to the heart and lungs; the device does not obstruct the flow of blood unless it is completely obstructed with trapped thrombus

Answer 2

inferior vena cava filter

Question 3

a detached fragment of thrombus, usually from the lower extremity veins, that travels through the inferior vena cava and right heart and lodges in a pulmonary artery

Answer 3

pulmonary embolus

Question 4

the space between the abdominal cavity and the muscles and bones of the posterior abdominal wall; vascular structures in the retroperitoneum include the inferior vena cava, the iliac veins, and the abdominal aorta

Answer 4

retroperitoneum

Question 5

partial or complete occlusion of a blood vessel as a result of clot

Answer 5

thrombosis

Question 6

IVC venous tributaries

Answer 6

hepatic veins
renal veins
common iliac veins
right adrenal vein
right ovarian vein or testicular vein
inferior phrenic vein
four lumbar veins
median sacral vein

Question 7

distended vein with echogenic material within lumen; absent flow; no signal

Answer 7

occlusive thrombus

Question 8

echogenic material that appears partially free floating and partially attached to the vessel wall; present or diminished flow; continuous flow; loss of respiratory and cardiac variation

Answer 8

partially occlusive thrombus

Question 9

intraluminal tumor originating from renal or hepatic veins or extrinsic mass; absent flow; collateral veins may be detected; no signal or continuous signal in partial obstruction; look for arterial flow within tumor

Answer 9

neoplastic obstruction

Question 10

echogenic metal structs of filter; echogenic material within lumen; absent flow; no signal or continuous signal with partial obstruction

Answer 10

IVC filter with thrombus

Question 11

Paired IVC or IVC on left side only

Answer 11

left-sided IVC

Question 12

The IVC drains into _____ or azygos vein with left sided IVC.

Answer 12

left renal vein

Question 13

intrahepatic IVC not visualized

Answer 13

absent intrahepatic IVC

Question 14

dilated vein; tissue bruit; pulsatile flow cephalad to fistula

Answer 14

caval fistulas

Question 15

Iliac vein compression syndrome is also known as:

Answer 15

May-Thurner’s syndrome

Question 16

Left iliac vein compressed by the right common iliac artery

Answer 16

May-Thurners syndrome

Question 17

drain lower extremities

Answer 17

external iliac veins

Question 18

continuation of common femoral veins

Answer 18

external iliac veins

Question 19

The external iliac veins begin at the ______

Answer 19

inguinal ligament

Question 20

drain pelvic viscera and musculature

Answer 20

internal iliac veins

Question 21

The internal iliac veins at level of ______ to form common iliac veins.

Answer 21

sacroiliac joints

Question 22

The IVC begins at the confluence of _________ at level of 5th lumbar vertebae

Answer 22

right and left common iliac veins

Question 23

The IVC terminates into the ______

Answer 23

right atrium

Question 24

conducts venous blood to heart from veins originating in the lower extremities and all organs and tissues inferior to diaphragm

Answer 24

IVC

Question 25

Mean diameter of IVC at level of renal veins

Answer 25

17- mm

Question 26

excessively large IVC diameter

Answer 26

mega cava

Question 27

Patient preparation

Answer 27

fast for 8 hours

Question 28

diameter of IVC may appear to change with phasic changes in abdominal pressure produced during respiration

Answer 28

quiet respiration

Question 29

results from propagation of a lower extremity venous thromboembolism represents most common pathologic finding

Answer 29

thrombosis

Question 30

An IVC filter is typically placed _____

Answer 30

just below level of renal veins

Question 31

echogenic lines that converge to a point near the level of the renal veins

Answer 31

IVC filter sonographic appearnace

Question 32

abnormal connections between IVC and surrounding vessels; may occur spontaneously or surgically created

Answer 32

caval fistulas

Question 33

During quiet respiration, the diaphragm descends, creating _____ pressure in abdomen and _____ pressure in chest

Answer 33

positive negative

Question 34

The proximal IVC waveform near the heart is:

Answer 34

pulsatile

Question 35

Flow in the distal IVC has a ____ waveform

Answer 35

phasic

Question 36

eliminates normal respiratory and cardiac variation in IVC and iliac veins; spectral analysis demonstrates continuous Doppler signals with a uniform flow velocity

Answer 36

partial obstruction of IVC

Question 37

lose of respiratory phasicity and inability to augment the signal with distal thigh compression

Answer 37

proximal obstruction consistent with iliac vein thrombosis

Question 38

occurs when a common iliac vein is compressed between the overlying iliac artery and underlying vertebral body; more commonly affects left renal vein

Answer 38

iliac vein compression syndome- May-Thurners syndrome

Question 39

monophasic flow without respiratory variation caudad to compression and increased flow velocity at point of compression

Answer 39

localized iliac vein stenosis consistent with IVCS

Question 40

Normal patency in IVC = ______ flow

Answer 40

phasic

Question 41

have flexible catheters that have ultrasound crystals embedded at tip to provide imaging of vessel lumen and wall structure

Answer 41

intravascular ultrasound

Question 42

Intravascular ultrasound can display colow flow by sampling up to ___ frames per second

Answer 42

30

Question 43

Which of the following vessels extends as the external iliac veins? a. common iliac vein b. great saphenous vein c. common femoral vein d. inferior vena cava

Answer 43

c

Question 44

In well-hydrated patients, what is the mean diameter of the inferior vena cava at the level of the renal veins?

Answer 44

17 to 20 mm

Question 45

Where does the left-sided IVC in a duplicate system typically terminate?

Answer 45

left renal vein

Question 46

Upon ultrasound examination, the hepatic veins are noted to drain directly into the right atrium. What does this finding suggest?

Answer 46

congenital absence of the inferior vena cava

Question 47

Which of the following is an impediment to visualizing the inferior vena cava? a. overlying bowel gas b. morbid obesity c. open abdominal wounds d. all of the above

Answer 47

d

Question 48

Applying pressure to the patient's abdomen may disperse bowel gas to make visualization of the IVC easier. Why must care be taken?

Answer 48

excessive force can compress the IVC

Question 49

On what signs and symptoms should the history and physical examination related to the inferior vena cava and iliac veins focus?

Answer 49

venouse thrombosis and insufficiency

Question 50

From a coronal plane in the left lateral decubitus position, what landmark can be used to identify the confluence of the common iliac veins to create the IVC?

Answer 50

inferior pole of the right kidney

Question 51

Which of the following describes normal IVC and iliac vein imaging characteristics? a. thin, echogenic walls with anechoic lumens b. thin, hypoechoic walls with hyperechoic lumens c. thick, muscular walls that are hypoechoic with hyperechoic lumens d. anechoic walls with hypoechoic lumens

Answer 51

a

Question 52

What is the most common pathologic finding in the IVC and iliac veins?

Answer 52

thrombus extension from deep venous thrombosis in th elegs

Question 53

Newly formed thrombus appears virtually _____, whereas more advanced thrombus appears ______.

Answer 53

anechoic hyperechoic

Question 54

From what do intraluminal tumors in the inferior vena cava most commonly arise?

Answer 54

renal cell carcinoma

Question 55

How can intraluminal tumors be distinguished from thrombosis?

Answer 55

tumors demonstrate flow within the mass

Question 56

Which Doppler mode would best be able to detect the slow-flow states that are typically seen in the inferior vena cava and iliac veins?

Answer 56

power Doppler

Question 57

In what condition can color flow Doppler be particularly useful in identifying tissue bruits and pulsatile flow?

Answer 57

aortocaval fistula

Question 58

During spectral Doppler analysis of the iliac system, continuous flow is noted in the common iliac veins bilaterally. What does this finding suggest?

Answer 58

obstruction in the inferior vena cava

Question 59

What is the condition that occurs when the common iliac vein is compressed between the overlying common iliac artery and the underlying vertebral artery?

Answer 59

May-Thurner's syndrome

Question 60

What is filter placement in the inferior vena cava designed to prevent?

Answer 60

pulmonary embolus

Question 61

Which of the following is a dependable marker for ultrasound identification of the level of the renal veins for IVC filter placement? a. superior mesenteric artery b. superior mesenteric vein c. left renal vein d. right renal artery

Answer 61

c

Question 62

On sonographic evaluation, which of the following describes the appearance of an IVC filter? a. hypoechoic, circular rings within the IVC lumen b. hyperechoic, circular rings within the IVC lumen c. echogenic lines that converge to a point d. hypoechoic lines that converge to a point

Answer 62

c

Question 63

The pelvic viscera and musculature are drained by the ____ veins.

Answer 63

internal iliac

Question 64

Patients with congestive heart failure may present with _____ or excessivly larger IVC diameter.

Answer 64

mega cava

Question 65

The presence of a fibrous septum in the IVC just cephalad to the insertion of the right hepatic vein would indicate _____ of the intrahepatic IVC.

Answer 65

membranous obstructionWhe

Question 66

When evaluating the IVC, the height of the bed should be adjusted so that the level of the patient's ______ is slight lower than the sonographer's _____ to ergonomically apply pressure

Answer 66

abdomen waist

Question 67

The inferior vena cava will appear oval shaped when viewed in a(n) _____ plane

Answer 67

transverse

Question 68

Landmarks that can be used to identify the IVC in a longitudinal plane include the _____, which lies to the left of the IVC, and the _____, which lies anterior to the IVC

Answer 68

abdomen liver

Question 69

The _____ plane may offer better imaging of the distal IVC and confluence of the common iliac veins.

Answer 69

coronal

Question 70

When evaluating the iliac veins, the patient should be positioned supine with the bed in a(N) ______ position

Answer 70

reverse Trendelenburg

Question 71

With quiet respiration, the _____ of the IVC may appear to change with the phasic changes in abdominal pressure.

Answer 71

diameter

Question 72

Acute thrombus may appear virtually anechoic on grayscale, therefore, ______ is/are important to the examination.

Answer 72

color flow/Doppler

Question 73

Thrombus that does not completely obstruct flow may be detected by grayscale imaging, demonstrating ______ echogenic material in the IVC or iliac vein.

Answer 73

free-floating

Question 74

Intraluminal tumors may completely or partially obstruct the IVC or iliac veins, resulting in _____ collateral veins and ______ of the distal IVC and iliac veins.

Answer 74

dilated distension

Question 75

An IVC filter is typically placed just ______ to the renal veins.

Answer 75

inferior

Question 76

Echogenic material found within and around an IVC filter represents trapped ______ and should be considered an abnormal finding.

Answer 76

thrombus

Question 77

In an ultrasound evaluation of the IVC with filter placement, visualization of a hematoma adjacent to the IVC likely indicates _____

Answer 77

strut perforation

Question 78

Normally, the proximal IVC demonstrates a _____ waveform pattern, whereas the distal IVC and iliac veins demonstrate respiratory _____.

Answer 78

pulsatility phasicity

Question 79

Unlike in the lower extremity veins, the iliac veins cannot be evaluated with transducer _____ maneuvers; therefore, spectral Doppler becomes important in detecting iliac vein thrombosis.

Answer 79

compression

Question 80

Cardiac pulsations detected in the iliac veins are often a sign of _____.

Answer 80

fluid overload

Question 81

Loss of respiratory phasicity and inability to augment the signal with distal thigh compression in an iliac vein indicate _______

Answer 81

a proximal obstruction consistene\t with iliac vein thombosis

Question 82

Treatment for iliac vein compression syndrome often involves balloon _____ and _____ placement in the compressed iliac vein.

Answer 82

angioplasty stent

Question 83

When using duplex ultrasound for guidance for IVC filter placement, the _______ can be used as a marker to determine the correct level for filter placement.

Answer 83

right renal artry

Question 84

When guiding filter placement, flushing saline through the initial sheath creates ______ at the tip, which can aid in identification.

Answer 84

echogenic turbulence

Question 85

Benefits of ultrasound guidance for filter placement include performance of the procedure at the bedside and lack of exposure to _____.

Answer 85

radiation

Question 86

Color imaging with IVUS can help differentiate the ____ lumen from the ______.

Answer 86

vessel wall structure

Question 87

IVUS has an excellent sensitivity in detecting ______ vein segments and in the placement of iliac vein stents.

Answer 87

obstructed