PMC4501637_01
US and Doppler images of a 26-year-old male patient. Sagittal US (A) and color Doppler (B) images through the upper abdomen on inspiration showing marked narrowing of IVC at the junction of intrahepatic and suprahepatic segments (arrow in A, B). Sagittal US (C) images through upper abdomen show normal (approximately 20%) respiratory IVC collapse with IVC diameter decreasing during inspiration and increasing on expiration. Pulsed wave Doppler (D) shows cardiofugal flow on inspiration and cardiopetal flow on expiration. Oblique axial greyscale US (E) and color Doppler (F) images show narrowing of left hepatic vein (arrow) and normal middle hepatic vein (arrowhead)
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It revealed dilated iliac veins and inferior vena cava (IVC) with abrupt narrowing at the junction of intrahepatic and suprahepatic IVC segments (Figure 1A) along with a narrowing of left hepatic vein (Figure 1E, 1F) and presence of multiple intrahepatic venous collaterals. IVC on inspiration (Figure 1B, 1D) and cardiopetal flow on expiration devoid of transmitted cardiac pulsation (Figure 1D). Intrahepatic IVC showed normal respiratory collapse, which amounted to approximately 20% (Figure 1C).
Sagittal CT images of the abdomen in venous phase (A) showing abrupt narrowing at the junction of intra- and suprahepatic IVC (large arrow) along with dilated paravertebral collaterals (small arrows). Coronal maximum intensity projection (MIP) CT images (B-D) showing dilated IVC, iliac vein, prominent venous collateral (arrow in B), a venous aneurysm (arrow in C), and dilated paravertebral collaterals (arrows in D)
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Subsequent computed tomography (CT) venogram confirmed marked narrowing at the junction of intrahepatic and suprahepatic segments of IVC along with dilated abdominal IVC with venous aneurysm, dilated iliac veins, paravertebral veins, as well as azygos and hemiazygos veins (Figures 2, 3).
Coronal MIP image shows partially recanalized umbilical vein (arrows in A). Axial (B, C) and sagittal (D) maximum intensity projection (MIP) CT images show dilated azygos vein (large arrowhead in C and double arrow in D) draining into SVC (arrowhead in C), dilated hemiazygos vein (small arrowhead in B) and intrahepatic collaterals (arrows in B).
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Subsequent computed tomography (CT) venogram confirmed marked narrowing at the junction of intrahepatic and suprahepatic segments of IVC along with dilated abdominal IVC with venous aneurysm, dilated iliac veins, paravertebral veins, as well as azygos and hemiazygos veins (Figures 2, 3). Left hepatic vein was narrowed with multiple intrahepatic collaterals (Figure 3B) and partially recanalized umbilical vein (Figure 3A).
Axial (A) and sagittal (B) CT images through the pelvis showing enlarged prostate. Axial (C) MIP CT image shows multiple prominent periprostatic venous channels (arrowheads). Axial CT image through the proximal bulbar urethra (D) shows prominent submucosal vascular channels (arrows).
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Multiple dilated venous channels were visualized in periprostatic region and along submucosal region of bulboprostatic urethra (Figure 4).