Hepatic changes in benign obstruction of the hepatic inferior vena cava: CT findings.

OBJECTIVE: The objective of this study was to describe CT findings of changes in the liver associated with benign obstruction of the hepatic inferior vena cava (IVC).

MATERIALS AND METHODS: For a 10-year period, 35 patients with benign obstruction of the hepatic IVC underwent contrast-enhanced CT of the abdomen. These patients were included in this retrospective study. CT scans were analyzed for morphologic changes and abnormal enhancement of the liver, changes in intrahepatic vessels, and additional findings that might be related to obstruction of the IVC.

RESULTS: Morphologic changes of the liver included hypertrophy of the caudate lobe (91%) and the left lobe (57%), atrophy of the right lobe (49%), and a nodular surface (74%). The most common pattern of attenuation change was areas of linear, irregular, or wedge-shaped hypoattenuation predominantly located in the peripheral portion of the liver (63%). Diffuse hypoattenuation was seen in six patients (19%) and was frequently found in areas in which hepatic veins filled with hypoattenuated thrombosis (67%). On CT, segmental IVC obstruction (80%) was seen as an obliterated segment of the hepatic IVC. However, membranous IVC obstruction (20%) was not seen on CT. The IVC below the level of obstruction was often revealed as rounded (89%) and occasionally contained thrombus (37%) or calcification (26%).

CONCLUSION: CT shows a broad spectrum of morphologic and attenuation changes of the liver and of the hepatic vessels in benign obstruction of the hepatic IVC.