Inferior vena cavagrams.

Abstract

Over half of the tumors of the retroperitoneal space, discounting primary organ neoplasms, such as those of the kidneys and pancreas, are due to in volvement of the lymph nodes (2) . The tumors that involve the para-aortic nodes are the lymphomas and metastatic carcinomas, the latter predominantly from a primary uterine or testicular source. Disease of these nodes is of prognostic and therapeutic significance. The retroperitoneal nodes lie along the main vascular trunks. Because of their distance from the rinary and intestinal tracts, these nodes must attain a considerable size before deforming the pacified ureter or stomach and intestine. Aortograms seldom reveal changes from expanding retroperitoneal masses, while the opacified inferior vena cava commonly shows defects produced by adjacent tumors (Fig . 7). The pressure within the aorta makes this vascular structure impervious to change from an extrinsic mass. The inferior vena cava, being thin-walled and of low in traluminal pressure, is easily distorted by firm, enlarged, tumorous masses. The results of inferior vena cavagrams were compared with gastrointestinal series and intravenous pyelograms and found to be more accurate not only in detecting lesions but al so in determining their extent (5). Technic Both femoral veins are catheterized percutaneously by the Seldinger method (6). The catheters are placed in the common iliac veins immediately caudad to their junction, and 30 c.c, of 35 per cent contrast medium is injected simultaneously through each catheter. The bilateral injection gives better filling than a unilateral injection. Six exposures are made, one every three-quarters of a second, with a film changer, during which time the patient is directed to suspend breathing in expiration and not to perform a Valsalva maneuver. The examination is carried out in the supine and the right posterior oblique or lateral positions. Upon completion of this examination, pyelograms are obtained; these are of superior quality because of the large amount of opaque medium used. This technic is safe and simple. We have utilized it in 150 examinations for retroperitoneal node enlargement, and no significant complications have occurred. Helander and Lindbom (5) have performed this procedure on 315 patients and noted its safety. Normal Anatomy The inferior vana cava is formed by the junction of the two common iliac veins opposite the fifth lumbar vertebra. As it ascends, it lies slightly to the right and parallel to the lumbar spine. It receives as tributaries: (a) the lumbar veins which anastomose with the azygos veins ; (b) the right spermatic or ovarian vein; (c) the renal veins; (d) the suprarenal veins; (e) the inferior phrenic veins; (f) the epatic veins. It is usually straight, although in older patients it may curve slightly to the right.