Reflux of contrast into inferior vena cava can be common findings seen on CT. It is considered a specific but insensitive sign of right-sided heart disease / right heart dysfunction at low contrast injection rates although the usefulness decreases with high injection rates.
Conditions associated with the phenomenon include:
- high flow contrast injection rates (through the upper arm)
- tricuspid regurgitation 8
-
pulmonary hypertension
- underlying pulmonary embolism
- right ventricular systolic dysfunction
- cardiac arrest/periarrest
Radiologist checklist
Things to look for and evaluate when interpreting this finding includes:
- contrast injection rate (can be enquired from technologist)
- concurrent presence of contrast reflux into hepatic veins +/- dilatation of hepatic veins
-
dependent layering of contrast in hepatic veins or IVC +/- IVC contrast level
- considered a sign of low cardiac output 2-4
- associated with conditions such as cardiac tamponade, myocardial infarction, and cardiac arrest
- concurrent presence of reflux of contrast into the azygous venous system
- other evidence of right heart dysfunction
- dilated right atrium
- dilated right ventricle
- interventricular septal flattening
- interventricular paradoxical bowing
- other evidence of pulmonary hypertension / elevated pulmonary pressures
Unable to process the form. Check for errors and try again.