Contrast flow phenomenon in inferior vena cava

Case contributed by Dr Chris O'Donnell


Non-specific abdominal pain. CT for exclusion of major pathology.

Patient Data

Age: 45
Gender: Male

Mixed opacified and unopacified blood in the IVC at and beyond the renal veins causing heterogeneous density in the IVC

Case Discussion

This is an artefact of mixed contrast opacified and non-opacified blood.  Contrast enhanced blood has entered the renal arteries and passed through the capillary bed to the renal veins.  Uniformly contrast enhanced blood in the renal veins enters the IVC (arrows) but is diluted by normal blood (without contrast) coming into the IVC from the pelvis and lower limbs.  This causes a swirl-like appearance that could be confused with thrombus (thus the name of "pseudothrombosis of the IVC").

It is a feature of early phase dynamic scanning.  Later scans times allow contrast-enhanced blood to enter the lower limbs thus mixing evenly with the renal vein blood.

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