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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5782_Библиотеки_им_академика_М_И_Перельмана.pdf
CHAPTER 5 Inferior Vena Cava Scanning Protocol 79
Inferior Vena Cava • Axial Survey
Transverse Plane • Transabdominal Anterior Approach
1. Begin scanning with the transducer perpendicular, at the midline
of the body, just inferior to the xiphoid process of the sternum.
LT
RT
2. Angle the transducer superiorly until the heart is identified by its
pulsations. Keeping your eyes on the screen, very slowly return the
transducer to a perpendicular position while looking for the oval
or round, anechoic IVC to come into sight just to the right of the
midline; anterior to the spine.
LT
RT
3. With the distal IVC in sight, very slightly rock or move the transducer from right to left, scanning completely through the IVC.
Continue this as you slowly slide the transducer inferiorly. Keep
your eyes on the screen; use the image as a guide to avoid losing
sight of the IVC. Note and evaluate the anterior hepatic vein tributaries as they empty into the IVC (Figure 5-1, B).
LT
RT
80 PART III Abdominal Scanning Protocols
4. Continue rocking and sliding the transducer inferiorly through
the middle and proximal IVC to the convergence of the common iliac veins. Note and evaluate the IVC’s lateral tributaries,
the renal veins. At the level of the common iliac veins, the view
will change from one large, round, echo-free structure (the IVC)
to two small, round, echo-free structures (the iliac veins), one
seen on each side of the midline. Evaluate the common iliac
veins by scanning through them inferiorly until you lose sight
of them.
LT
RT
NOTE: An alternative method for locating the axial section of the distal
IVC begins by viewing a longitudinal section of the distal IVC from a sagittal plane. From that position, slowly rotate the transducer 90 degrees
into the transverse scanning plane. The axial view of the IVC should
come directly into sight.
RT
LT
Inferior Vena Cava Required Images
Inferior Vena Cava • Longitudinal Images
Sagittal Plane • Transabdominal Anterior Approach
NOTE: The required images are a small representation of what a sonographer visualizes during a study. Therefore, the images should provide
the interpreting physician with the most telling and technically accurate
information available.
NOTE: Measurements of the IVC are not required unless indicated by
pathology.
CHAPTER 5 Inferior Vena Cava Scanning Protocol 81
Posterior
Anterior
Inferior
Hepatic vein
Posterior
Gastro-
1. Longitudinal image of the DISTAL IVC to include the diaphragm
and hepatic vein(s).
Superior
Diaphragm
Labeled: IVC SAG DISTAL
2. Longitudinal image of the MID IVC at the level of the head of the
pancreas.
Portal vein
Distal IVC
Hepatic
artery
Superior
Portal
vein
Right renal artery
Labeled: IVC SAG MID
Anterior
Gallbladder
Liver
Gallbladder neck
fold shadow
Common
bile duct
duodenal
artery
Inferior
Pancreas
head
Middle IVC
82 PART III Abdominal Scanning Protocols
Anterior
Posterior
Anterior
3. Longitudinal image of the PROXIMAL IVC.
Superior
Proximal IVC
Posterior
Labeled: IVC SAG PROX
4. Longitudinal image of the COMMON ILIAC VEINS.
Superior
Bowel
Proximal IVC
IVC origin
Inferior
Bowel
Inferior
Left common
iliac vein
Right common
iliac vein
Labeled: SAG CIV or
SAG CIV RT OBL or
RT COR CIV
NOTE: To avoid moving the patient, longitudinal images of the common iliac veins in the decubitus position can be taken following the
axial images. Although the coronal plane approach can be used with
the patient supine, the decubitus position is generally easier and can be
helpful if the patient has obscuring bowel gas anteriorly.
CHAPTER 5 Inferior Vena Cava Scanning Protocol 83
Posterior
Anterior
Anterior
Posterior
Inferior Vena Cava • Axial Images
Transverse Plane • Transabdominal Anterior Approach
5. Axial image of the DISTAL IVC to include the hepatic veins.
Labeled: IVC TRV DISTAL
6. Axial image of the MID IVC at the level of the renal veins.
Middle
hepatic
vein
Distal IVC
Right hepatic vein
LeftRight
Left hepatic
vein
Gallbladder
Right
Right
renal vein
Right
renal artery
Labeled: IVC TRV MID
Liver
Spine
Left
Middle IVC
Left renal
vein
Aorta
84 PART III Abdominal Scanning Protocols
Posterior
Anterior
Posterior
Anterior
7. Axial image of the PROXIMAL IVC.
Labeled: IVC SAG DISTAL
8. Axial image of the COMMON ILIAC VEINS.
LeftRight
Proximal IVC
Common
iliac vein
Labeled: IVC TRV CIV
Spine
Common
iliac arteries
LeftRight
Common
iliac vein
CHAPTER 5 Inferior Vena Cava Scanning Protocol 85
Posterior
Hepatic
Inferior
Posterior
Anterior
Required Images When the Inferior Vena Cava is Part of Another Study
1. Longitudinal image of the DISTAL and MID IVC.
Anterior
Portal
Superior
vein
Liver
Vertebrae
Distal and middle IVC
Labeled: IVC SAG DISTAL/MID
2. Axial image of the DISTAL IVC to include the hepatic veins.
Middle
hepatic
vein
artery
Small
bowel
shadow
LeftRight
Labeled: IVC TRV DISTAL
Left hepatic
vein
Distal IVC
Right hepatic vein
86 PART III Abdominal Scanning Protocols
Review Questions
Answers on page 628.
1. The lie of the IVC within the body is
a) midsagittal.
b) superior to inferior.
c) oblique.
d) transverse.
2. The long axis of the IVC is seen from a(n)
a) sagittal or coronal scanning plane.
b) transverse scanning plane.
c) axial section.
d) left lateral decubitus position.
3. Longitudinal views of the renal vein tributaries are seen in a
a) sagittal or coronal scanning plane.
b) transverse scanning plane.
c) midsagittal plane.
d) longitudinal section.
4. Axial views of the renal vein tributaries are seen in a
a) sagittal or coronal scanning plane.
b) transverse scanning plane.
c) midsagittal plane.
d) longitudinal section.
5. The IVC
a) tributaries include the splenic vein.
b) tributaries include the splenic vein and superior mesenteric vein.
c) passes through a deep fossa on the inferior surface of the liver at
the level where it is anterior to the left renal artery.
d) passes through a deep fossa on the posterior surface of the liver
between the caudate lobe and bare area.
6. The size of the IVC is normal up to
a) 4 cm
b) 1.5 cm
c) 2 cm
d) 3.5 cm
CHAPTER 5 Inferior Vena Cava Scanning Protocol 87
7. The proximal IVC is the portion
a) that extends superiorly from the common iliac veins to just
below the level of the renal veins.
b) adjacent to the diaphragm and posterior to the body of the liver.
c) posterior to the head of the pancreas at the level of the renal
veins.
d) that enters the heart.
8. The mid portion of the IVC is
a) the portion that extends superiorly from the common iliac veins
to just below the level of the renal veins.
b) adjacent to the diaphragm and posterior to the body of the liver.
c) posterior to the head of the pancreas at the level of the renal veins.
d) the portion that enters the heart.
9. The distal IVC is the portion
a) that extends superiorly from the common iliac veins to just
below the level of the renal veins.
b) that extends superior to the renal veins to the right atrium of
the heart.
c) posterior to the head of the pancreas at the level of the renal
veins.
d) just superior to the common iliac veins.
10. Beginning posteriorly, and in correct order by the location in the
body, the IVC is
a) just to the right of and at the same level as the spine, posterior
to the splenic and common hepatic arteries, body of the pan-
creas, right lobe of the liver.
b) anterior and just to the right of the spine, anterior to the right
renal artery, posterior to the head of the pancreas, gastroduode-
nal artery, portal splenic confluence, and the liver.
c) anterior to the spine, posterior to the gastroesophageal junction,
splenic vein, head of the pancreas, portion of the duodenum,
right lobe of the liver.
d) anterior to the spine and kidneys, posterior to the gastroesopha-
geal junction, splenic vein, head of the pancreas, portion of the
duodenum, right lobe of the liver.
88 PART III Abdominal Scanning Protocols
11. The left renal vein has a(n) ______________ course compared with
the right renal vein.
a) identical
b) shorter
c) wider
d) longer
12. All of the following are IVC tributaries except the
a) hepatic veins.
b) right renal vein.
c) superior mesenteric vein.
d) left renal vein.
13. The primary function of the IVC is to
a) carry deoxygenated blood from the heart.
b) serve as a lymph drainage channel.
c) carry deoxygenated blood to the heart.
d) regulate metabolism.
14. The right and left common iliac veins are ______________ the right
and left common iliac arteries.
a) posterior to
b) anterior to
c) wider than
d) longer than
15. The IVC is medial to all of the following except the
a) right adrenal gland.
b) caudate lobe.
c) right kidney.
d) right ureter.
16. The IVC is anterior to all of the following except the
a) transverse duodenum.
b) right crus of the diaphragm.
c) right adrenal gland.
d) psoas major muscle.