Diagnostic ultrasound ( PDFDrive )

CHAPTER 12 The Retroperitoneum 463
A
B
C
D
FIG. 12.36 Pelvic Congestion Syndrome. (A) Pelvic transvaginal gray-scale and (B) color Doppler images of dilated left ovarian veins with
the largest vein measuring 9 mm in diameter. (C) Sagittal transvaginal image shows dilated uterine arcuate veins. These connect the left ovarian
vein with the right. (D) Pelvic venography in a different patient performed during ovarian vein embolization. Numerous collateral veins arise from
the left ovarian vein and cross the pelvis. These would be expected to connect to the right ovarian vein. See also Video 12.15.
standard. 148,150 Venographic indings include an enlarged let
ovarian vein, retrograde low of contrast into the let ovarian
vein, and delayed clearance of contrast. 145,150 Medical management
includes treatment with medroxyprogesterone acetate or goserelin
acetate (gonadotropin-releasing hormone agonist). 151 Transcatheter
embolization of the ovarian veins may be performed as a
primary treatment or in patients with failed medical management.
It results in clinical improvement in 60% to 100% of the patients 150
(Fig. 12.36 and Video 12.15).
Budd-Chiari Syndrome
Budd-Chiari syndrome is a rare condition caused by obstruction
to outlow of the hepatic veins. In Caucasians the condition is
oten related to hypercoagulability. In Asians, membranous
obstruction of the IVC is the most common cause. 152 When
there is isolated stenosis of the IVC, percutaneous transluminal
angioplasty with or without stent placement is oten successful.
Transjugular intrahepatic portosystemic shunt (TIPS) placement
is oten efective for hepatic vein obstruction. 153
Budd-Chiari syndrome has many intrahepatic manifestations.
154,155 IVC manifestations are visible sonographically and
include an IVC web just above the hepatic veins, 152 narrowing
of the intrahepatic IVC caused by swelling of the liver, and IVC
thrombosis. 153
Inferior Vena Cava Neoplasms
Neoplasm of the IVC is rare and most oten occurs in the setting
of extension of solid organ tumors extending through their venous
drainage to enter the IVC. his phenomenon is seen when renal
cell carcinoma extends through the renal veins into the IVC.
he same phenomenon can occur with hepatocellular and
adrenocortical carcinoma extending through the hepatic and
adrenal veins into the IVC.
Primary neoplasms of the IVC are even rarer. Leiomyosarcoma
can occur at other sites in the systemic veins as well, but most
oten it arises in the IVC.
Ultrasound is not the primary method of imaging these
tumors. When indings of IVC tumor involvement are seen