Journal Pre-proof

Inferior vena cava web diagnosed on endoscopic ultrasound

Suprabhat Giri, MD, DM, Sumaswi Angadi, MD, DNB, Sukanya Bhrugumalla, MD,
DNB

PII: S0016-5107(23)02688-3
DOI: https://doi.org/10.1016/j.gie.2023.06.039
Reference: YMGE 13811

To appear in: Gastrointestinal Endoscopy

Received Date: 10 February 2023

Revised Date: 23 February 2023
Accepted Date: 22 June 2023

Please cite this article as: Giri S, Angadi S, Bhrugumalla S, Inferior vena cava web diagnosed
on endoscopic ultrasound, Gastrointestinal Endoscopy (2023), doi: https://doi.org/10.1016/
j.gie.2023.06.039.

This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition
of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of
record. This version will undergo additional copyediting, typesetting and review before it is published
in its final form, but we are providing this version to give early visibility of the article. Please note that,
during the production process, errors may be discovered which could affect the content, and all legal
disclaimers that apply to the journal pertain.

Copyright © 2023 by the American Society for Gastrointestinal Endoscopy

Title: Inferior vena cava web diagnosed on endoscopic ultrasound

Authors: Suprabhat Giri1, MD, DM, Sumaswi Angadi1, MD, DNB, Sukanya Bhrugumalla1, MD, DNB

1
Department of Gastroenterology, Nizam's Institute of Medical Sciences, Hyderabad, India

Corresponding author:

Dr. Suprabhat Giri,

Assistant Professor,

f
oo
Department of Gastroenterology,

r
4th floor, Specialty block,

Nizam's Institute of Medical Sciences,

-p
re
Hyderabad, Telangana, India - 500082
lP

Contact no.: +91-96681-44964

na

Email: supg19167@gmail.com
ur
Jo

Conflicts of interest: None

Financial disclosures: None

Title: Inferior vena cava web diagnosed on endoscopic ultrasound

A 42-years old female presented with a history of right upper quadrant pain for last six months with intermittent

pedal edema. She had undergone a transabdominal ultrasound with Doppler, which was suboptimal due to

excessive bowel gas and reported as hepatomegaly with altered liver echotexture. Her liver stiffness with transient

elastography was 41 kPa. All serological workups for the cause of liver disease were negative. Contrast enhanced

CT showed non-enhancement of the inferior vena cava (IVC) in the venous phase but normal enhancement in the

delayed phase with no obvious thrombus. Because of caudate lobe hypertrophy with dysmorphic liver, Budd-

Chiari syndrome (BCS) was suspected, and she underwent endoscopic ultrasound (EUS). On EUS, there was a

suspected web in the retrohepatic IVC just above the insertion of the hepatic veins (HV) on grey-scale (Fig. A)

f
oo
and color Doppler (Fig. B). The patient underwent an IVC gram (Fig. C), confirming the diagnosis, followed by

venoplasty. EUS of the HVs and the tributaries may give a mapping comparable to CT and MRI with additional

r
-p
superiority in assessing the flow dynamics of HVs. Thus, in patients with suspected BCS with no direct evidence

on cross-sectional imaging, EUS can serve as an alternative diagnostic modality.

re
lP
na
ur
Jo
Jo
ur
na
lP
re
-p
ro
of
Jo
ur
na
lP
re
-p
ro
of
Jo
ur
na
lP
re
-p
ro
of