eMedicine Specialties > General Surgery > Abdomen

Inferior Vena Caval Thrombosis: Workup

Author: Luis G Fernandez, MD, FACS, FASAS, FCCP, FCCM, FICS, Assistant Clinical Professor of Surgery and Family Practice, University of Texas Health Science Center; Chairman, Division of Trauma Surgery and Surgical Critical Care, Chief of Critical Care Units, Trinity Mother Francis Health System
Coauthor(s): Douglas M Geehan, MD, Associate Professor, Department of Surgery, University of Missouri at Kansas City
Contributor Information and Disclosures

Updated: Dec 29, 2008

Workup

Laboratory Studies

  • No specific laboratory test includes or excludes the diagnosis of inferior vena caval thrombosis (IVCT).
  • Assessing clotting and fibrinolytic systems may be helpful.
    • Confounding factors include variations caused by heparin and warfarin therapy.
    • Dynamic factors involved with acute thrombosis may also alter measured parameters because of the active consumption of factor by the thrombus.
  • Protein C, protein S, antithrombin III, and anticardiolipin studies may all be helpful, but many of these assessments can only be made after the fact.

Imaging Studies

  • Virtually all radiologic modalities have been applied to the diagnosis of IVCT. Although evidence of collateralization may be evident on plain radiographs, this modality should not be used as a primary diagnostic tool. Contrast venography, duplex scanning, CT scanning, and MRI all have defined roles in diagnosis.
  • Contrast venography
    • This modality is the criterion standard for diagnosis of deep vein thrombosis (DVT).
    • Two access sites may be required in order to document extent of thrombus in situations of inferior vena cava (IVC) occlusion by clot.
    • The caudal extent of clot may be overestimated because of preferential flow into collaterals.
    • Pros include (1) limited false-positive study results; (2) access for therapy, thrombolytic agents, or caval interrupting device; and (3) access for pulmonary angiography (if indicated).
    • Cons include (1) invasiveness, (2) possible need for more than one puncture, and (3) possible postprocedure DVT.
  • Duplex scanning
    • Pros include (1) noninvasiveness; (2) portability; (3) efficacy in helping diagnose DVT at the femoral level and, to some extent, to the distal iliac level; (4) possible help in visualizing dilated collaterals, and (5) possibly more accurate assessment of extent of thrombus than venography.
    • Cons include (1) operator dependence, (2) anatomic limitations, (3) less reliable diagnosis within the abdomen because of greater difficulty in assessing venous compressibility, and (4) lost respiratory phasicity above the renal veins because of retrograde transmission of the cardiac cycle through the valveless IVC.
  • CT scanning
    • CT scans are often obtained as part of the diagnostic evaluation for the primary process (eg, malignancy).
    • The use of intravenous contrast materials is typically required.
    • False-positive study results sometimes occur.
    • Pseudothrombosis, particularly of the infrarenal IVC, is generally thought to result from the variable amounts of contrast in the cava above and below the renal veins. It may also result from collapse of the IVC at the diaphragm while patients are supine.
  • MRI
    • MRI allows for examination in multiple planes and for estimation of the thrombus age.
    • Reconstructive imaging technology can generate images similar to those seen with venography.
    • Pros include (1) noninvasiveness, (2) lack of any ionizing radiation, and (3) help in determining proximal extent of thrombosis.
    • Cons include (1) cost, (2) accessibility, and (3) turbulent flow that may be read falsely as clot.

Diagnostic Procedures

  • Although other modalities may have a more primary role, IVCT may still be diagnosed intraoperatively in patients who were treated with laparotomy for their primary problem.

More on Inferior Vena Caval Thrombosis

Overview: Inferior Vena Caval Thrombosis
Workup: Inferior Vena Caval Thrombosis
Treatment: Inferior Vena Caval Thrombosis
Follow-up: Inferior Vena Caval Thrombosis
Multimedia: Inferior Vena Caval Thrombosis
References
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References

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Further Reading

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Keywords

inferior vena caval thrombosis, IVC thrombosis, IVCT, deep venous thrombosis, DVT, thrombophlebitis, renal cell carcinoma, renal vein thrombosis, RVT, hepatic venous thrombosis, HVT, Virchow triad, Virchow's triad, Budd-Chiari syndrome

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Contributor Information and Disclosures

Author

Luis G Fernandez, MD, FACS, FASAS, FCCP, FCCM, FICS, Assistant Clinical Professor of Surgery and Family Practice, University of Texas Health Science Center; Chairman, Division of Trauma Surgery and Surgical Critical Care, Chief of Critical Care Units, Trinity Mother Francis Health System
Luis G Fernandez, MD, FACS, FASAS, FCCP, FCCM, FICS is a member of the following medical societies: American Association for the Surgery of Trauma, American College of Chest Physicians, American College of Legal Medicine, American College of Surgeons, American Society of Abdominal Surgeons, American Society of General Surgeons, American Society of General Surgeons, American Society of Law Medicine and Ethics, American Trauma Society, Association for Surgical Education, Association of Military Surgeons of the US, Chicago Medical Society, Illinois State Medical Society, International College of Surgeons, New York Academy of Sciences, Pan American Trauma Society, Society of Critical Care Medicine, Society of Laparoendoscopic Surgeons, Southeastern Surgical Congress, Texas Medical Association, and Undersea and Hyperbaric Medical Society
Disclosure: Nothing to disclose.

Coauthor(s)

Douglas M Geehan, MD, Associate Professor, Department of Surgery, University of Missouri at Kansas City
Douglas M Geehan, MD is a member of the following medical societies: American College of Surgeons, American Institute of Ultrasound in Medicine, American Medical Association, Association for Academic Surgery, Phi Beta Kappa, Society of American Gastrointestinal and Endoscopic Surgeons, and Society of Critical Care Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Michael A Grosso, MD, Consulting Staff, Department of Cardiothoracic Surgery, St Francis Hospital
Michael A Grosso, MD is a member of the following medical societies: American College of Surgeons, Society of Thoracic Surgeons, and Society of University Surgeons
Disclosure: Nothing to disclose.

CME Editor

Paolo Zamboni, MD, Professor of Surgery, Chief of Day Surgery Unit, Chair of Vascular Diseases Center, University of Ferrara, Italy
Paolo Zamboni, MD is a member of the following medical societies: American Venous Forum and New York Academy of Sciences
Disclosure: Nothing to disclose.

Chief Editor

John Geibel, MD, DSc, MA, Vice Chairman, Professor, Department of Surgery, Section of Gastrointestinal Medicine and Department of Cellular and Molecular Physiology, Yale University School of Medicine; Director of Surgical Research, Department of Surgery, Yale-New Haven Hospital
John Geibel, MD, DSc, MA is a member of the following medical societies: American Gastroenterological Association, American Physiological Society, American Society of Nephrology, Association for Academic Surgery, International Society of Nephrology, New York Academy of Sciences, and Society for Surgery of the Alimentary Tract
Disclosure: AMGEN Royalty Other

 
 
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