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British Journal of Radiology 75 (2002),87-88 © 2002 The British Institute of Radiology

Correspondence

Pulsatile IVC opacification in valvular heart disease

The Editor—Sir,

Dr Collins and colleagues made key CT observations regarding tricuspid regurgitation [1], including the important early dense opacification of the inferior vena cara (IVC).

We would like to present a further observation using a rapid spiral CT technique. An 82-year-old patient was referred for CT of the abdomen with a preliminary diagnosis of subacute bacterial endocarditis and suspected carcinoma of the colon following cultivation of Streptococcus bovis from his blood.

CT was performed on a Siemens Somatom plus 4 CT system following the iv administration of 100 ml lopropamide at 2 ml s-1 and a delay of 25 s to capture the arterial phase of a biphasic liver examination.

We were initially puzzled by the varying opacification of the IVC on sequential arterial phase images (Figures 1GoA–D). On some images the IVC was virtually unopacified (Figures 1GoA and C), while on others it was fairly well opacified with dense contrast medium (Figures 1GoB and D), long before contrast medium could have entered the IVC from the renal vein, etc.



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  		Figure 1. Sequential arterial phase CT images of the liver.

 
After discussion, it was concluded that a very dynamic flow phenomenon was the likeliest explanation and that the appearance of the IVC depended on systolic/diastolic variation, perhaps augmented by tricuspid regurgitation.

Further discussion revealed that the patient had known aortic and mitral insufficiency and replacement of both valves for probable rheumatic heart disease; however, echocardiography did not reveal gross tricuspid regurgitation.

Nevertheless, this observed variability in opacification of the IVC should probably be added to the signs of cardiac valvular disease.

Yours etc.,

K Faraj 1 A K Dixon 1 and D E A Luxton 2

Departments of 1Radiology and 2Care of theElderly, Box 219, Addenbrooke's NHS Trust, Hills Road, Cambridge CB2 2QQ, UK

Received for publication October 10, 2001. Accepted for publication October 16, 2001.

References

  1. Collins MA, Pidgeon JW, FitzGerald R. Computed tomography manifestations of tricuspid regurgitation. Br J Radiol 1995;68:1058–60.[Abstract/Free Full Text]




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