"Patients with renal cell carcinoma in whom multidetector computerized tomography fails to detect tumor thrombus are unlikely to have a tumor thrombus found at surgery that would change the surgical approach." The Accuracy of Multidetector Computerized Tomography for Evaluating Tumor Thrombus in Patients With Renal Cell Carcinoma
Guzzo TJ, Pierorazio PM, Schaeffer EM, Fishman EK, Allaf ME
J Urology Vol 181,486-491 February 2009 " Multidetector computerized tomography with 3-dimensional mapping is an effective imaging modality for accurately characterizing the level of venous thrombus in patients with renal cell carcinoma." The Accuracy of Multidetector Computerized Tomography for Evaluating Tumor Thrombus in Patients With Renal Cell Carcinoma
Guzzo TJ, Pierorazio PM, Schaeffer EM, Fishman EK, Allaf ME
J Urology Vol 181,486-491 February 2009 - Tumor Thrombus vs Bland Thrombus?
- Tumor thrombus typically
- Have gross invasion of tumor parenchyma into adjacent vein
- Abnormal arterial vascularity (within the thrombus) of the thrombus
- Irregular venous lumen expansion - Which tumors have the highest risk for venous thrombosis?
- Uterus
- Brain
- leukemia Acute vs Chronic Venous Thrombosis Acute thrombosis
- Thrombi are homogeneous
- expand the lumen
- Located centrally in the vessel
- Peripheral residual flow common
Chronic thrombosis
- Thrombi are heterogeneous
- Decreased vein diameter
- Are peripherally attached to the vessel wall
- Venous Thrombosis in Cancer Patients
- Hypercoagulability states due to indirect pathway activation by production of procoagulents
- Venous stasis due to reduced mobility (cachexia, surgery) or to compression by tumors
- Vessel wall damage by direct invasion of vessels on by indwelling catheters "The purpose of this article is to review the imaging of venous thrombosis in patients with cancer." Imaging Presentation of Venous Thrombosis in Patients With Cancer
Khosa F et al.
AJR 2919; 194:1099-1108- "High speed MDCT has the potential to replace traditional imaging techniques in the evaluation of pathologic processes involving the IVC. The ability to acquire near isotrophic data allows high-quality reconstructions in the sagittal and coronal planes and thus overcomes one of the major limitations of CT in evaluating the IVC."
Imaging of the Inferior Vena Cava with MDCT
Sheth S, Fishman EK
AJR 2007;189:1243-1251
- Splanchnic Artery Aneuyrsms: Sites of Origin
- Splenic artery 60%
- Hepatic artery 20%
- SMA 5.5%
- Celiac artery 4%
- Pancreatic aa. 2%
- GDA 1.5%
- "The performance characteristics of CTV and deep venous sonography were similar when compared with a clinical standard. The results support the use of indirect CTV after CT pulmonary angiography as an alternative to sonography in the ICU patient."
Prospective Comparison of Indirect CT Venography Versus Venous Sonography in ICU Patients
Taffomi MJ et al. AJR 2005; 185:457-462
- "Retrograde opacification of the inferior vena cava or hepatic veins on CT is a specific but insensitive sign of right sided heart disease at low contrast injection rates, but the usefullness of this classic sign decreases with high injection rates."
Clinical Relevance of Retrograde Inferior Vena Cava or Hepatic Vein Opacification During Contrast Enhanced CT Yeh BM et al. AJR 2004; 183:1227-1232
- Retrograde IVC or Hepatic Vein Opacification: Causes
- High injection rates
- Tricuspid atresia
- Pulmonary hypertension
- Right ventricular systolic dysfunction
- Factoid: The left ovarian vein arises off the left renal vein while the right ovarian vein arises directly off the IVC.
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