Evaluation of the inferior vena cava by sonography and venography in children with renal and hepatic tumors.

Ultrasonography was used to examine 81 children with intra-abdominal or retroperitoneal malignancies for tumor extension into the inferior vena cava (IVC). In seven of the 18 patients with Wilms tumors and three of the seven patients with hepatic tumors, the IVC ws sonographically abnormal. Venography was also performed in five patients with Wilms tumors. However, percutaneous transfemoral venacavography did not always allow differentiation between extrinsic compression and intracaval tumor. It is suggested that venacavography, when necessary, should be performed via the brachial vein route and that the catheter be advanced into the right atrium. If an injection in this chamber does not result in enough reflux into the retrohepatic IVC for adequate evaluation, the catheter should be advanced into the IVC and a second injection made. However, ultrasonography is the preferred modality for evaluation of the IVC in children because it is the most accurate method and is noninvasive. Real-time ultrasonography makes it possible to distinguish between tumor extension into the lumen of the IVC and extrinsic compression of the vessel.