Inferior vena cava web

Inferior vena cava (IVC) webs are an uncommon condition characterized by obstruction of the hepatic segment of the inferior vena cava by a membrane or fibrous band. This is often associated with occlusion of one or more of the hepatic veins.

Clinical presentation

If there is hepatic vein involvement, patients may present with Budd-Chiari syndrome. 

Pathology

Etiology

It may be a congenital/developmental anomaly. More commonly they arise as fibrotic bands as post-thrombotic sequelae with the regressed thrombus replaced by a fibrous laminar structure. It can lead to hepatic outflow obstruc­tion.

Radiographic features

• intrahepatic IVC may have a linear filling defect representing the web
• features of hepatic vein obstruction may be present (also see: Budd-Chiari syndrome):
  • flow reversal on Doppler ultrasound
  • non-obstructed hepatic veins may be dilated
  • collateral pathways between obstructed hepatic veins