Case Author(s): Thomas H. Vreeland,MD , 07/16/94 . Rating: #D2, #Q4

Diagnosis: Inferior Vena Cava Obstruction

Brief history:

This patient is a 59 year old woman with a history of uterine carcinoma, who is being evaluated to rule out osseous metastatic disease.


Anterior and Posterior views at different intensities

View main image(bs) in a separate image viewer

Full history/Diagnosis is available below

Diagnosis: Inferior Vena Cava Obstruction

Full history:

This patient is a 59 year old woman with a history of uterine carcinoma, which was resected and treated with radiation in 1991. The patient now complains of progressive lower back pain. An MRI examination of the lumbar spine performed on 7/15/94 demonstrated inferior vena cava and bilateral common iliac thrombosis. The patient was noted to have abnormal signal in the sacrum (possible insufficiency fracture) and involvement of the L3 vertebral body on the MRI performed on 7/15/94. The patient is being evaluated to rule out osseous metastatic disease.


Bone Scintigraphy:(7/16/94)

(1) Marked soft tissue swelling of the abdomen and the lower extremities

(2) Mildly increased activity in the third lumbar vertebrate noted on anterior images

(3) No scintigraphic correlate for the sacral abnormalities noted on the MRI from 7/15/94.

(4) Central area of photopenia involving the right kidney in the region of the collecting system, suggesting hydronephorsis

MRI Examination of the Lumbar Spine: (7/15/94)

(1) Possible invasion of L3 by adjacent soft tissue mass

(2) Hydronephrosis of the right kidney

(3) No evidence of thecal sac or neural foramina impingement

MRI Examination of Pelvis (7/14/94):

(1) Possible sacral insufficiency fracture

(2) IVC and bilateral common iliac vein thrombosis


(1) The marked soft tissue activity noted in the abdomen and lower extremities, especially when compared to the upper extremities, suggests the possibility of venous or lymphatic obstruction.

(2) The scintigraphic findings involving L3 are nonspecific. Degenerative changes would be the most common cause of such scintigraphic findings.

(3) The findings involving the right kidney are relatively nonspecific; however, in this setting, they are suspicious for hydronephosis. Alternatively, a space-occupying lesion in the collecting system (hematoma or tumor) would be included in the differential diagnosis, in the proper clinical setting.

Major teaching point(s):

Vascular or lymphatic obstruction should be suspected when gross asymmetry of soft tissue activity is noted in one extremity (or in half of the body in this case) when compared to the rest of the body. The diagnosis of IVC obstruction is often known or suspected in a patient prior to scintigraphic examination; however, occasionally, this diagnosis is first detected on scintigraphic examinations.

Differential Diagnosis List

(1) Vascular or lymphatic obstruction (intrinsic or extrinsic) (2) Congenital

ACR Codes and Keywords:

References and General Discussion of Bone Scintigraphy (Anatomic field:Vascular and Lymphatic Systems, Category:Organ specific)

Search for similar cases.

Edit this case

Add comments about this case

Read comments about this case

Return to the Teaching File home page.

Case number: bs006

Copyright by Wash U MO