Optimal Imaging Technique to Diagnose IVC Thrombus
A 74 year old female with a history of coronary artery disease and immobility due to body habitus presented to her primary care provider with pleuritic chest pain, concerning for pulmonary embolism. A venogram of the inferior vena cava (IVC) and placement of an IVC filter was ordered. As seen in figure 1, the initial anterior-posterior (AP) venogram showed no evidence of thrombus. However, bowing, some subtle narrowing of the IVC, and lack of an adequate lateral film prompted a repeat study. As shown in figures 2 and 3 (anterior-posterior and lateral, respectively), the repeat study showed clear evidence of thrombus in the IVC (shown by ellipse in figures). The correct diagnosis resulted in IVC placement from an SVC approach, placing the IVC filter in a suprarenal vein location.