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Fulltext Ultrasonography measurement of inferior vena cava diameter of blood donors as predictors for early blood loss in tertiary hospital northeastern, Malaysia

Shaik Farid AW, Mohd Hashairi F, Nik Hisamuddin NA, Chew KS, Rashidi A

Med J Malaysia, 2013 Dec;68(6):465-8.
PMID: 24632914 MyJurnal

According to the class of hypovolaemic shock, a blood loss less than 750 ml is not associated with the physiological changes. As a result it may cause a delay in fluid resuscitation. We postulate inferior vena cava (IVC) diameter reduction in inspiration and expiration may resemble the significant volume of blood loss in a healthy adult. We conducted a study to examine the changes of the IVC diameter pre and post blood donation.The inferior vena cava diameter during inspiration (IVCi) and expiration (IVCe) were measured using ultrasound (GE HEALTH) in supine position before and after blood donation of 450 ml. Paired t-test and Wilcoxin rank test were used to analyse the data. Forty two blood donors enrolled during the study period. The mean age of blood donors was 32.3 +/- 8.9 and mainly male blood donors. The mean IVCe of pre and post blood donation was 18.5 +/- 6.2 mm (95%CI 18.23, 18.74) and 16.6 +/- 6.6 mm (95%CI 16.35, 16.76) respectively. Meanwhile, the mean IVCi of pre and post blood donation was 17.1 +/- 8.6 mm (95%CI 16.89,17.30) and 15.6 +/- 6.6 mm (95%CI 15.43,15.81) respectively. The mean difference of IVCe pre and post blood donation was 1.9 +/- 0.5 mm (95%CI 1.75, 2.13) (p<0.001). In contrast, the mean difference of IVCi pre and post blood donation was 1.5 +/- 0.5 mm (95%CI 1.34, 1.68) (p<0.001). As a conclusion, the measurement of IVC diameter by ultrasound can predict the volume of blood loss in simulated type 1 hypovolaemia patient.

Matched MeSH terms: Vena Cava, Inferior
Fulltext Ultrasonographic assessment of inferior vena cava/abdominal aorta diameter index: a new approach of assessing hypovolemic shock class 1

Rahman NH, Ahmad R, Kareem MM, Mohammed MI

Int J Emerg Med, 2016 Dec;9(1):8.
PMID: 26894896 DOI: 10.1186/s12245-016-0101-z

We designed this study to expand the usage of ultrasound to detect early occurrence of hypovolemia. We explore the potential use of inferior vena cava (IVC) and abdominal aorta (AA) diameter index (IVC:AA) measured ultrasonographically to detect class 1 hypovolemic shock with blood loss less than 15%.ᅟ

Matched MeSH terms: Vena Cava, Inferior
Ultrasonographic Measurements of the Liver, Gallbladder Wall Thickness, Inferior Vena Cava, Portal Vein and Pancreas in an Urban Region, Malaysia

Khammas ASA, Mahmud R

J Med Ultrasound, 2020 10 01;29(1):26-31.
PMID: 34084713 DOI: 10.4103/JMU.JMU_53_20

Background: Ultrasonographic (USG) measurements of the liver length, gallbladder wall thickness (GBWT), diameters of the inferior vena cava (IVC), portal vein (PV), and pancreas are valuable and reliable in diagnosis hepatobiliary and pancreas conditions. This study is aimed to determine the normal values of liver length, GBWT, AP diameters of the IVC and PV, AP diameter of the head and body of the pancreas.
Methods: A prospective cross-sectional study was carried out in this study. A total of the 408 participants were randomly recruited using a systematic method. According to the USG reports, the subjects who had normal USG report for liver, biliary system, and pancreas were described as normals, whereas the subjects who had hepatobiliary diseases such as fatty liver, liver cysts, hemangioma, cirrhosis, gallbladder wall thickening, acute cholecystitis, gallstones, and polyps were recorded as abnormal subjects.
Results: Of the 408 participants with a mean of 52.6 ± 8.4 years old. Of those, 294 (72.1%) participants were normal and 114 (27.9%) subjects were reported as abnormal. More than half of the study population was males, 52.9% versus 47.1% of females. There was a significant difference of liver length, head, and body of the pancreas between genders (P = 0.004, 0.002, and P < 0.001, respectively). Moreover, the pancreatic body only was significantly correlated with age (P = 0.026). There also was a significant difference of the liver length, head, and body of the pancreas between normal and abnormal subjects (P < 0.001, P = 0.007, and P < 0.001).
Conclusion: Liver length, diameter of the head, and body of the pancreas were significantly associated with gender and hepatobiliary diseases. In addition, only the diameter of the body of the pancreas was significantly correlated with age.

Matched MeSH terms: Vena Cava, Inferior
Fulltext Triple right testicular veins and their variant termination and communications

Nayak SB, Kodimajalu Vasudeva S

Heliyon, 2020 Sep;6(9):e05014.
PMID: 32995649 DOI: 10.1016/j.heliyon.2020.e05014

Testicular veins are known to show many variations in their origin, course and termination. Some of their variations can lead to male sterility. We report a unique variation of right testicular vein here. Pampiniform plexus reduced to three testicular veins (medial, middle and lateral) at the deep inguinal ring on the right side. The medial vein terminated into the right renal vein, the middle vein terminated into the inferior vena cava above the level of right renal vein (close to the suprarenal gland) and the lateral vein terminated partly into the veins in the capsules of the kidney and partly into the veins under the diaphragm. The medial and middle testicular veins were connected through an oblique communicating vein. The middle and lateral testicular veins were also connected to each other through another oblique communicating vein. Knowledge of this case could be useful to radiologists, nephrologists and surgeons in general.

Matched MeSH terms: Vena Cava, Inferior
Fulltext Transcatheter closure of patent ductus arteriosus and interruption of inferior vena cava with azygous continuation using an Amplatzer duct occluder II

Koh GT, Ai Mokthar S, Hamzah A, Kaur J

Ann Pediatr Cardiol, 2009 Jul;2(2):159-61.
PMID: 20808631 DOI: 10.4103/0974-2069.58320

We report a case of transcatheter closure of patent ductus arteriosus using the new Amplatzer duct occluder II in an adult patient with interrupted inferior vena cava with azygous continuation via the femoral artery approach.

Matched MeSH terms: Vena Cava, Inferior
Fulltext The value of pre-operative embolisation in primary inferior vena cava paraganglioma

Zaki FM, Osman SS, Abdul Manaf Z, Mahadevan J, Yahya M

Malays J Med Sci, 2011 Apr;18(2):70-3.
PMID: 22135590

We report a case of a 13-year-old boy who complained of progressive abdominal distension and symptoms of anaemia. Radiological investigations revealed that the child had a hypervascular tumour of the inferior vena cava (IVC). Unfortunately, the child presented with acute lower gastrointestinal bleed soon after the investigation. He underwent an urgent pre-operative embolisation, aimed to reduce the tumour vascularity. A total resection of the tumour, right nephrectomy, and partial duodenal resection were done within 24 hours post-embolisation. The child was stable postoperatively. The histopathological examination revealed chromogranin-positive paraganglioma originating from the IVC. We highlight the radiological findings of rare primary IVC paraganglioma and the role of embolisation prior to surgical removal of the tumour.

Matched MeSH terms: Vena Cava, Inferior
Fulltext Sporadic renal angiomyolipoma with IVC extension

Priyanka G, Poh EY, Yeong SS

Med J Malaysia, 2013 Dec;68(6):473-4.
PMID: 24632917

Angiomyolipomas (AML) are the most common mesenchymal renal neoplasms arising in the cortex or medulla. Intra-renal and retroperitoneal hemorrhages have been frequently reported. AML can exceptionally involve the renal vein and inferior vena cava. We report a case with extension into the inferior vena cava.

Matched MeSH terms: Vena Cava, Inferior
Fulltext Spontaneous internal ilio-iliac fistula in an elderly woman presenting as heart failure

Tan G, Abdullah B, Kunanayagam S

Biomed Imaging Interv J, 2006 Apr;2(2):e13.
PMID: 21614225 MyJurnal DOI: 10.2349/biij.2.2.e13

Acquired intra-abdominal arteriovenous fistulas (AVFs) are a rare disorder where the communication most commonly occurs between abdominal aorta and inferior vena cava. Ilio-iliac AVF has been reported previously, but is exceedingly rare. We present a case of spontaneous ilio-iliac AVF in an elderly woman who presented with symptoms of right heart failure where the diagnosis was not considered. The computed tomographic (CT) and angiographic features are described. The current status of management as well as a review of the literature is also presented.

Matched MeSH terms: Vena Cava, Inferior
Robot-assisted Cavectomy Versus Thrombectomy for Level II Inferior Vena Cava Thrombus: Decision-making Scheme and Multi-institutional Analysis

Shi T, Huang Q, Liu K, Du S, Fan Y, Yang L, et al.

Eur Urol, 2020 10;78(4):592-602.
PMID: 32305170 DOI: 10.1016/j.eururo.2020.03.020

BACKGROUND: Robot-assisted thrombectomy (RAT) for inferior vena cava (IVC) thrombus (RAT-IVCT) is being increasingly reported. However, the techniques and indications for robot-assisted cavectomy (RAC) for IVC thrombus are not well described.
OBJECTIVE: To develop a decision-making program and analyze multi-institutional outcomes of RAC-IVCT versus RAT-IVCT.
DESIGN, SETTING, AND PARTICIPANTS: Ninety patients with renal cell carcinoma (RCC) with level II IVCT were included from eight Chinese urological centers, and underwent RAC-IVCT (30 patients) or RAT-IVCT (60 patients) from June 2013 to January 2019.
SURGICAL PROCEDURE: The surgical strategy was based on IVCT imaging characteristics. RAT-IVCT was performed with standardized cavotomy, thrombectomy, and IVC reconstruction. RAC-IVCT was mainly performed in patients with extensive IVC wall invasion when the collateral blood vessels were well-established. For right-sided RCC, the IVC from the infrarenal vein to the infrahepatic veins was stapled. For left-sided RCC, the IVC from the suprarenal vein to the infrahepatic veins was removed and caudal IVC reconstruction was performed to ensure the right renal vein returned through the IVC collaterals.
MEASUREMENTS: Clinicopathological, operative, and survival outcomes were collected and analyzed.
RESULTS AND LIMITATIONS: All procedures were successfully performed without open conversion. The median operation time (268 vs 190 min) and estimated blood loss (1500 vs 400 ml) were significantly greater for RAC-IVCT versus RAT-IVCT (both p < 0.001). IVC invasion was a risk factor for progression-free and overall survival at midterm follow-up. Large-volume and long-term follow-up studies are needed.
CONCLUSIONS: RAC-IVCT or RAT-IVCT represents an alternative minimally invasive approach for selected RCC patients with level II IVCT. Selection of RAC-IVCT or RAT-IVCT is mainly based on preoperative IVCT imaging characteristics, including the presence of IVC wall invasion, the affected kidney, and establishment of the collateral circulation.
PATIENT SUMMARY: In this study we found that robotic surgeries for level II inferior vena cava thrombus were feasible and safe. Preoperative imaging played an important role in establishing an appropriate surgical plan.

Matched MeSH terms: Vena Cava, Inferior/surgery*
Fulltext Retrocaval Ureter: Report of 2 Different Clinical Spectrums

Khairul Asri, Malinda, Tee, S.C., Sundram, Woo, S.

Malaysian Journal of Medicine and Health Sciences, 2014;10(1):39-42.
MyJurnal

etrocaval ureter is a relatively rare anomaly where ureteric obstruction may occur as a result of ureter passes behind the inferior vena cava (IVC), hence, compressing it between the IVC and the vertebrae. We report 2 cases of retrocaval ureter with different presentations. One patient was managed surgically with minimally invasive approach and the other was managed conservatively.

Matched MeSH terms: Vena Cava, Inferior
Fulltext Renal angiomyolipoma with inferior vena caval involvement

Haritharan T, Sritharan S, Bhimji S

Med J Malaysia, 2006 Oct;61(4):493-5.
PMID: 17243531 MyJurnal

Renal angiomyolipomas are innocuous benign tumours which rarely behave aggressively. This is a case of a 48 year old Malay lady presenting with right sided abdominal pain associated with a large right sided abdominal mass. She was diagnosed with renal angiomyolipoma of the right kidney complicated by inferior vena caval tumour thrombosis. She successfully underwent a radical nephrectomy and inferior vena caval thrombectomy using cardiopulmonary bypass and deep hypothermic circulatory arrest.

Matched MeSH terms: Vena Cava, Inferior/pathology*; Vena Cava, Inferior/surgery
Fulltext Radical resection of primary leiomyosarcoma of inferior vena cava

Ikhwan Sani Mohamad, Sivabalan Nadarajan, Azim Idris, Hairol Othman, Affirul Chairil, Razman Jarmin

Malaysian Journal of Medicine and Health Sciences, 2018;14(1):61-64.
MyJurnal

Leiomyosarcoma of the Inferior Vena Cava (IVC) is a rare soft tissue tumour which accounts for only 0.5% of all soft tissue sarcomas. The patients usually presented with non specific clinical signs and often diagnosed at advanced stage. We reported a case of a 58-year-old lady who presented with right sided abdominal pain for 6 months. CT scan showed large Level 2 IVC tumour which encased the right renal vein and had no clear plane of demarcation with the caudate lobe of the liver. She underwent radical resection of the IVC tumour with the right kidney removed en bloc. Vascular reconstruction was not performed as established collateral veins present. She was nursed in Intensive Care Unit for 2 days and discharged well at day 5 post operatively. Histopathological examination results revealed leiomyosarcoma of IVC.

Matched MeSH terms: Vena Cava, Inferior
Persistent valve of systemic venous sinus: a cause of neonatal cyanosis

Qureshi AU, Latiff HA, Sivalingam S

Cardiol Young, 2014 Aug;24(4):756-9.
PMID: 24016801 DOI: 10.1017/S1047951113001200

Incomplete involution of valve of systemic venous sinus can present across a spectrum of anatomical lesions ranging from eustachian valve to division of right atrium (cor triatriatum dexter) with overlapping features. We present the case of a neonate presenting with cyanosis, having persistent valve of systemic venous sinus with anatomical details of the redundant tissue in right atrium suggesting an intermediate form between Chiari network and division of right atrium.

Matched MeSH terms: Vena Cava, Inferior/abnormalities; Vena Cava, Inferior/ultrasonography*
Performance of emergency physicians in point-of-care echocardiography following limited training

Bustam A, Noor Azhar M, Singh Veriah R, Arumugam K, Loch A

Emerg Med J, 2014 May;31(5):369-73.
PMID: 23428721 DOI: 10.1136/emermed-2012-201789

OBJECTIVES: The aim of this study was to evaluate if emergency medicine trainees with a short duration of training in echocardiography could perform and interpret bedside-focused echocardiography reliably on emergency department patients.
METHODS: Following a web-based learning module and 3 h of proctored practical training, emergency medicine trainees were evaluated in technical and interpretative skills in estimating left ventricular function, detection of pericardial effusion and inferior vena cava (IVC) diameter measurements using bedside-focused echocardiography on emergency department patients. An inter-rater agreement analysis was performed between the trainees and a board-certified cardiologist.
RESULTS: 100 focused echocardiography examinations were performed by nine emergency medicine trainees. Agreement between the trainees and the cardiologist was 93% (K=0.79, 95% CI 0.773 to 0.842) for visual estimation of left ventricular function, 92.9% (K=0.80, 95% CI 0.636 to 0.882) for quantitative left ventricular ejection fraction by M-mode measurements, 98% (K=0.74, 95% CI 0.396 to 1.000) for the detection of pericardial effusion, and 64.2% (K=0.45, 95% CI 0.383 to 0.467) for IVC diameter assessment. The Bland-Altman limits of agreement for left ventricular function was -9.5% to 13.7%, and a Pearson's correlation yielded a value of 0.82 (p<0.0001, 95% CI 0.734 to 0.881). The trainees detected pericardial effusion with a sensitivity of 60%, specificity of 100%, positive predictive value of 100% and negative predictive value of 97.9%.
CONCLUSIONS: Emergency medicine trainees were found to be able to perform and interpret focused echocardiography reliably after a short duration of training.
Study site: Trauma and emergency department, University of Malaya Medical Centre, Kuala Lumpur

Matched MeSH terms: Vena Cava, Inferior/ultrasonography
Oblique Retro-Aortic Left Renal Vein and its Clinical Importance

Bhagavath P, Nayak BS, Monteiro NP, Kumar GP

Kathmandu Univ Med J (KUMJ), 2016 7 18;13(52):369-71.
PMID: 27423291

Kidneys are the organs that remove the waste products of the metabolic activities. A smooth blood flow to the kidneys is essential to maintain their function. Abnormalities of the renal vasculature may result not only in impairing the renal function but can lead to conditions like varicocele. During an autopsy of an adult male, we observed renal vascular variations. The left renal vein had a retro-aortic course before its termination into the inferior vena cava. It was joined with the inferior vena cava at the level of inferior mesenteric artery with an acute angle. The left testicular vein joined the left renal vein with an acute angle. The right kidney was supplied by two renal arteries. The knowledge about retro-aortic course of the left renal vein may be important during renal transplantation. The oblique course of left renal vein and the termination of left testicular vein into it with an acute angle may increase the chances of left sided varicocele.

Matched MeSH terms: Vena Cava, Inferior
Fulltext New concepts of hepatic amoebiasis

Balasegaram M

Ann Surg, 1972 Apr;175(4):528-34.
PMID: 4259839
Matched MeSH terms: Vena Cava, Inferior
NEPHRON-SPARING SURGERY IN PATIENTS WITH RENAL CELL CARCINOMA EXTENDING TO THE MAIN RENAL VEIN: INTRARENAL AND EXTRARENAL THROMBECTOMY

Shchukin D, Lisova G, Khareba G, Polyakov M, Antonyan I, Kopytsya M, et al.

Georgian Med News, 2019 Dec.
PMID: 32011290

In most cases RCC with venous extension is an indication for radical nephrectomy. However, in patients with imperative indications for nephron-sparing surgery a kidney resection with thrombectomy in rare situations is possible. We present a surgical technique for nephron-sparing surgery in patients with tumor spreading into the main renal vein. From 2007 to 2019 seven partial nephrectomies with removal of the tumor thrombus from the main renal vein were performed. Absolute imperative indications were recorded in 6 (85.7%) patients (4 with solitary kidney, 2 with bilateral tumors). Dimensions of renal tumor averaged 6.5±2.3 cm. Intravenous part of the tumor penetrated the initial portion of the renal vein in 3 cases, main trunk of the renal vein in 3 cases, and cavarenal portion of the IVC in 1 case. The average length of the tumor thrombus was 24.0±6.9 mm, and the width was 9.3±4.8 mm. Tumor thrombi were classified as intrarenal and extrarenal. In accordance with this principle surgical procedures were divided into partial nephrectomy with intrarenal (3/42.9%) and extrarenal thrombectomy (4/57.1%). Intrarenal thrombectomy was characterized by thrombus removal out of the vein lumen from the side of the kidney resection area, while extrarenal thrombectomy included additional opening the lumen of the main renal vein or inferior vena cava (IVC). In one patient hypothermic perfusion of the kidney in situ was used. In two cases the extracorporeal partial nephrectomy with kidney autotransplantation was performed. Warm ischemia time averaged 14.0 minutes. The time of ischemia during hypothermic perfusion in situ reached 76 minutes, the time of cold ischemia during extracorporeal surgery averaged 68.0 minutes. The volume of blood loss did not exceed an average of 621.4±146.8 ml. Early postoperative complications occurred in 4 (57.1%) cases (bleeding -1, ischemic stroke -1, deterioration of renal failure -2). Postoperative mortality was registered in 1 patient due to bleeding and heart failure. The follow-up period averaged 28.7±18.9 months. Distant metastases occurred in 1 (14.3%) patient after 16 months. Local tumor recurrence in the remnant kidney after nephron-sparing surgery was not detected in any case. Nephron-sparing surgery may be used to treat patients with kidney tumors and neoplastic venous thrombosis. However, this complex surgical approach requires further technical improvement.

Matched MeSH terms: Vena Cava, Inferior
Multiple subcutaneous puncture and stoma bag drainage for gross lower limb edema: a case report

Beng TS, Chin LE

J Palliat Med, 2010 Aug;13(8):1037-8.
PMID: 20712471 DOI: 10.1089/jpm.2009.0314

We present a case of gross lower limb edema in a 21-year-old man with an intra-abdominal malignant fibrous histiocytoma. He had a 1-month history of lower limb edema secondary to inferior vena caval obstruction. His edema failed to respond to a combination of diuretics, oral frusemide 40 mg daily and oral spironolactone 100 mg daily. Subcutaneous drainage of both lower limbs with butterfly needles was performed with minimal improvement. However, he gained significant symptomatic relief with multiple subcutaneous punctures and stoma bag drainage. A total of 12.8 L of serous fluid was drained with this simple and effective method. This is the first report of the use of this method.

Matched MeSH terms: Vena Cava, Inferior
Fulltext Multiple renal arteries with an ascending upward renal Vein of the right kidney: a case report

Al-Shibli S.M.

International Medical Journal Malaysia, 2014;13(1):57-60.
MyJurnal

As it is known; the majority of the human subjects has two renal arteries arising from the abdominal aorta; each will supply one kidney but in 30% of individuals, certain variations can be found. Accessory renal arteries constitute the most common and clinically important of these variations. For our case report, we are presenting one of these different variations that can be found in the blood supply of the kidneys. During dissecting the abdomen of an approximately 65 years-old male cadaver, multiple variations were found. There were double right renal arteries with prehilar branching of the upper renal artery. We found also that the right renal vein ascended upwards obliquely before ending in the lateral aspect of the inferior vena cava. Variation in the renal vessels is relatively common, especially multiple renal arteries, and can go smoothly without any abnormalities with the function of the kidney, but in some situations like renal transplantations, vascular reconstructions, and various surgical and radiological diagnostic techniques, the study of the anatomy of these variations is of crucial importance to decrease the patient morbidity during surgical procedures.

Matched MeSH terms: Vena Cava, Inferior
Fulltext Metastatic Adenocarcinoma Presenting as Extensive Cavoatrial Tumor Thrombus

Johari B, Abdul Aziz YF, Krishnasamy S, Looi LM, Hashim SA, Raja Mokhtar RA

Iran J Radiol, 2015 Apr;12(2):e11197.
PMID: 26060549 DOI: 10.5812/iranjradiol.11197

The presence of tumor thrombus in the right atrium is frequently the result of direct intraluminal extension of infra-diaphragmatic malignancy into the inferior vena cava (IVC) or supradiaphragmatic carcinoma into the superior vena cava (SVC). Right atrial tumor thrombus with extension into both SVC and IVC has not been reported in the literature. We present a patient who presented with symptoms of right atrial and SVC obstruction. Imaging revealed presence of a thrombus in the right atrium, extending to the SVC and IVC, with the additional findings of a left adrenal mass and multiple liver lesions. The histopathological examination of the right atrial mass revealed metastatic adenocarcinoma cells. The patient was given a presumptive diagnosis of metastatic adenocarcinoma, most likely adrenal in origin, with multiple hepatic lesions suspicious for metastasis. The clinical outcome of the patient was not favorable; the patient succumbed before the adrenal mass could be confirmed to be the primary tumor. This case highlights that in patients manifesting with extensive cavoatrial thrombus as, the existence of primary carcinoma should be considered especially in the adrenal cortex or in the lung.

Matched MeSH terms: Vena Cava, Inferior

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