IVC clot: not every big IVC is congestion

Question 1A breathless patient has a wide IVC with echogenic material in its lumen. What does this suggest?

1. aFluid overload only
2. bPneumobilia
3. cIVC thrombus or tumour, not just raised pressure
4. dA normal IVC

Question 2Why add colour Doppler when the IVC lumen looks black?

1. aColour measures IVC pressure
2. bIt is never needed
3. cFresh clot can be almost anechoic and only shows as a flow defect
4. dColour shows tamponade

Question 3A mobile mass extends from the IVC into the right atrium. How do you manage it?

1. aWith diuretics
2. bBy repeating the scan tomorrow
3. cAs a routine outpatient finding
4. dAs an emergency, a clot in transit, with immediate senior help

Question 4Which of these can make the IVC wide and still?

1. aOnly dehydration
2. bTamponade, pulmonary embolism, fluid overload and IVC thrombus
3. cOnly fluid overload
4. dOnly pneumothorax

Question 5Where can tumour thrombus in the IVC come from?

1. aThe thyroid
2. bThe appendix
3. cThe gallbladder
4. dThe kidney or the liver