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Gastrointestinal Case of the Day

¹ Department of Radiology, SL 54, Tulane University Medical Center, 1430 Tulane Ave, New Orleans, LA 70112.

View larger version (86K): [in a new window]   Figure 1.  Doppler US image shows absence of blood flow in the IVC.

View larger version (105K): [in a new window]   Figure 2a.  (a) Contrast material–enhanced CT scan of the chest demonstrates a large mass within the right atrium with focal areas of enhancement (arrowheads). The azygos and hemiazygos veins are enlarged (arrows). There are small, bilateral pleural effusions, and the right hemidiaphragm is elevated secondary to an enlarged liver. (b) Contrast-enhanced CT scan of the upper abdomen shows a large, mildly enhancing mass within the hepatic portion of the IVC (arrowheads) extending into the liver. The mass is seen compressing the portal vein and obstructing hepatic venous outflow. The hepatic veins are not enhanced, and there is mottled enhancement of the liver parenchyma. (c) Contrast-enhanced CT scan of the lower abdomen shows a tumor within the IVC and enhancement of the IVC wall (arrowhead). There is an area of soft-tissue attenuation surrounding the retroperitoneal vascular structures as well as mesenteric venous congestion and mild anasarca of the abdominal wall soft tissues (arrows).

View larger version (130K): [in a new window]   Figure 2b.  (a) Contrast material–enhanced CT scan of the chest demonstrates a large mass within the right atrium with focal areas of enhancement (arrowheads). The azygos and hemiazygos veins are enlarged (arrows). There are small, bilateral pleural effusions, and the right hemidiaphragm is elevated secondary to an enlarged liver. (b) Contrast-enhanced CT scan of the upper abdomen shows a large, mildly enhancing mass within the hepatic portion of the IVC (arrowheads) extending into the liver. The mass is seen compressing the portal vein and obstructing hepatic venous outflow. The hepatic veins are not enhanced, and there is mottled enhancement of the liver parenchyma. (c) Contrast-enhanced CT scan of the lower abdomen shows a tumor within the IVC and enhancement of the IVC wall (arrowhead). There is an area of soft-tissue attenuation surrounding the retroperitoneal vascular structures as well as mesenteric venous congestion and mild anasarca of the abdominal wall soft tissues (arrows).

View larger version (123K): [in a new window]   Figure 2c.  (a) Contrast material–enhanced CT scan of the chest demonstrates a large mass within the right atrium with focal areas of enhancement (arrowheads). The azygos and hemiazygos veins are enlarged (arrows). There are small, bilateral pleural effusions, and the right hemidiaphragm is elevated secondary to an enlarged liver. (b) Contrast-enhanced CT scan of the upper abdomen shows a large, mildly enhancing mass within the hepatic portion of the IVC (arrowheads) extending into the liver. The mass is seen compressing the portal vein and obstructing hepatic venous outflow. The hepatic veins are not enhanced, and there is mottled enhancement of the liver parenchyma. (c) Contrast-enhanced CT scan of the lower abdomen shows a tumor within the IVC and enhancement of the IVC wall (arrowhead). There is an area of soft-tissue attenuation surrounding the retroperitoneal vascular structures as well as mesenteric venous congestion and mild anasarca of the abdominal wall soft tissues (arrows).

View larger version (43K): [in a new window]   Figure 3a.  (a) Photograph of a gross autopsy specimen demonstrates leiomyosarcoma occluding the IVC (arrows) and extending into the right atrium. (b) Photograph of the cut surface of the liver demonstrates the "nutmeg" appearance of hepatic venous congestion.

View larger version (93K): [in a new window]   Figure 3b.  (a) Photograph of a gross autopsy specimen demonstrates leiomyosarcoma occluding the IVC (arrows) and extending into the right atrium. (b) Photograph of the cut surface of the liver demonstrates the "nutmeg" appearance of hepatic venous congestion.

View larger version (187K): [in a new window]   Figure 4.  Low-power photomicrograph (original magnification, x15; hematoxylin-eosin stain) demonstrates bundles of the atypical smooth muscle cells of leiomyosarcoma of the IVC.