Upright Inferior Vena Cavoqraphy

For a number of years at Memorial Hospital for Cancer and Allied Diseases, New York, inferior vena cavography has been found valuable in conjunction with lymphangiography and intravenous pyelography in study of retroperitoneal nodal disease, especially the lymphomas. Generally, however, we have been dissatisfied with the quality of our inferior vena cavograms as performed by technics currently in use. An improved technic has been developed, directed toward better visualization of the upper inferior vena cava. Material and Method Inferior vena cavography was performed 92 times in 90 patients. Three injections per examination were made whenever feasible for comparison of accepted technics with improvements. All were performed intravenously with the Seldinger catheterization method, using meglumine iothalamate 60 per cent, power injection, and anteroposterior and lateral projections. Pressure, volume, and rate of injection, filming rate and delay, exposure time, number, location and design of catheters, patient position, tourniquets, and the Valsalva maneuver were investigated. Results Injections at 75 to 525 PSI (pounds per square inch) on a Taveras power injector produced optimal studies at pressures as low as 225 PSI. When supine cross-table lateral projections and anteroposterior projections were employed with unilateral catheterization, contrast material quantities of 40 cc were required for reasonable opacification in average adults. Larger amounts did not eliminate the problem of streaming and layering of nonopacified blood. When the upright position was adopted, the use of up to 60 cc of contrast material became desirable. This was due to loss from reflux into the contralateral common iliac vein and ipsilateral direct common iliac vein filling. Optimum injection time was 60 cc per one and three-quarters seconds or about 10 g of iodine per second. Deliberately lengthening injection times by varying a speed reduction valve resulted in neither more complete mixing of contrast material with nonopacified blood nor in opacification of the entire inferior vena cava on a single film, a desirable technic. In uncomplicated cases serial filming with a 14 × 17-in, roll film changer added little information in comparison with electronically synchronized single filming technic. Best opacification occurred on a single film obtained after injection of 50 cc of contrast material. The most advantageous exposure time was found to be in the range of threetenths to seven- tenths second. Shorter times resulted in turbulent artefacts, and longer ones in blurring of the inferior vena cava in certain cases. The Valsalva maneuver resulted in stasis of the contrast column with poor filling of the upper inferior vena cava, similar to the findings of Helander and Lindbom (13, 15), without improvement in nonopacified areas.