Hepatic Vein Visualization by Intravenous Carbon Dioxide Injection

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Abstract
Carbon dioxide (CO,) was injected intravenously in 22 patients with suspected pericardial effusion and 48 noncardiac patients to demonstrate the hepatic veins radiographically. The hepatic veins were visualized in 78% of patients without hepatic disease, but in only 8% with hepatic disease (cirrhosis in most cases). The hepatic vein diameters ranged from 5-15 mm. By placing the patient in a 15 head-down tilt, visualization of the right atrium was improved. The infrequency of hepatic vein visualization in cirrhotic patients is discussed. A pressure- flow phenomenon, rather than anatomical narrowing, may be responsible for the nonvisualization in this group. The failure to demonstrate the hepatic veins regularly in the cirrhotics places a limitation on the clinical usefulness of this procedure. The use of intravenous CO, in the demonstration of other intra-abdominal veins has not yet been fully explored. The right renal vein was seen in 9 patients and a long segment of the inferior vena cava in 2. In 4 post-shunt patients the portacaval anastomosis was not visualized.