Heart & Cardiology/IVC dilated

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Question
My 22 year old son recently was c/o chest discomfort, he had an EKG and CXR normal and then he went for an echo and the results are : dilated ICV apprx. 2.5cm with no resp. variation.
normal L ventricular size, contractility and wall thickness, ejection fraction approx. 55 to 60%
normal L/R atrial size and global function
aortic root and valve appears normal, tricuspid and pulmonic
normal pericardial study and no intracardiac mass
On Wednesday coming up he is having an US of the IVC and Abdominal Aorta.
My question is what can be causing this and how is it treated?
Thank you,
Aleida

Answer
Hi, (http://blog.myheart.net)

This is an interesting question.

The IVC is basically the large vein that carries blood back from the body to the heart. When echocardiograms are performed the IVC diameter is measured in order to help estimate the pressure in the heart. As the pressure in the heart increases, often this is transmitted back to the IVC which may dilate as a result of the increased pressure. This is not always the case however. In your sons case it seems this was incidentally noted on the echocardiogram. The IVC upper limit is usually 20mm, also the usual pattern is for it to collapse to a degree in inspiration.

The otherwise normal echo is reassuring. It's likely now that the dilation has been noted the other tests are being ordered to rule out serious causes of dilation, ill discuss some of these. The normal echo has somewhat ruled out causes such as heart failure, a severely leaky tricuspid valve or right sided heart dilation. Anything that causes obstruction to flow in the IVC such as internal or external masses or clots can cause pressure increase and dilation. These would typically be accompanied by abdominal symptoms however. Liver disease with concomitant disease of the venous system of the liver and advanced kidney disease may also be implicated however once again it would be extremely rare for this to present as incidental IVC dilation. Finally there is also a recognized association of a high level of athletic training with IVC dilation, this is not considered dangerous.

If these causes have been ruled out then I would call this idiopathic dilation of the IVC which basically means its there but no underlying cause can be found. No specific treatment other than routine medical check ups and observation would be needed for a diagnosis of idiopathic dilation of the IVC.

I would suspect here that this is the most likely case. The abdominal ultrasounds are a reasonable next step to rule out obvious causes.  

Hope that was helpful,  

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Mustafa Ahmed MD

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Cardiology, Interventional Cardiology, Cardiac Surgery, Hypertension, Pulmonary Embolism, Structural and Valve Disease

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MD from The Royal Victoria University of Manchester, England Medicine, Cardiology, Interventional Cardiology, Research Training - University of Alabama

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