Inferior vena cava (ultrasound)

Case contributed by Dr David Carroll

Presentation

Asymptomatic male.

Patient Data

Age: 30 years
Gender: Male
Ultrasound

Subcostal

The Inferior vena cava pictured in the cine-loop demonstrates respirophasic changes in a spontaneously breathing patient

The annotated still image depicts a nearly fully collapsed Inferior vena cava (red arrows) 

Case Discussion

Ultrasonographic measurement of inferior vena cava (IVC) diameter and degree of respirophasic collapse was initially utilized by nephrologists and subsequently cardiologists. It has more recently been integrated into several critical care/emergency ultrasound protocols as a non-invasive estimate of central venous pressure (CVP). 

Considerable heterogeneity exists among authors regarding the exact relationship between Right atrial pressure and the behavior of the IVC; the American Society of Echocardiography recommends that the following specific values be used when guiding interventions:

  • maximum size < 2.1 cm and a collapse >50% during sniff = right atrial pressure 0–5 mm Hg
  • maximum size > 2.1 cm; collapses >50% during sniff = 5–10 mm Hg
  • maximum size > 2.1; collapses <50% during sniff = 10–20 mm Hg

Learning Points:

Baseline diameter of the IVC and the degree of change induced by inspiration are used to calculate the Caval Index, reported as a percentage; a number close to 100% is indicative of almost complete collapse, while a number close to 0% suggest minimal collapse

Caval Index, or IVCC, is performed by calculating the difference between the inspiratory and expiratory diameters, and dividing by the latter (normal >50%).

In the appropriate clinical context, a plethoric IVC with minimal respiratory variation is congruent with elevated filling pressures, while a collapsed slit-like IVC may provide supporting evidence for intravascular volume depletion.

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Case information

rID: 61384
Published: 2nd Jul 2018
Last edited: 26th Aug 2018
System: Vascular
Tag: pocus
Inclusion in quiz mode: Excluded
Institution: St. George's University

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