Chronic SVC Stenosis with Caudal Blood Flow of Dilated Abdominal Veins 60 y/o hx of seizures & cirrhosis presenting after seizure & found to have distended abdominal wall veins. What is the cause? Pay Attention to the direction of Venous Flow -> may suggest site of venous obstruction. Normal venous flow in the abdomen is typically Cephalad (towards the head) above the navel and Caudad (towards the feet) below the navel. For practical use: the maneuver should be performed both above and below the umbilicus. - Portal HTN- flow is always AWAY from the umbilicus 2/2 development of the portosystemic collaterals - SVC & IVC obstructions can also lead abdominal vein distention! - IVC obstruction - flow will be cephalad (towards SVC) - SVC obstruction - flow will be caudad (towards IVC) Though this pt does have cirrhosis, venous flow was dominantly caudad not typical for portal hypertension suggesting a possible SVC obstruction. CT imaging showed chronic stenosis of his SVC and additional lumbar & paraseophageal collaterals. Dr. Patrick Fadden @ptfaddenMD #Milking #SVC #syndrome #Stenosis #obstruction #abdominal #veins #Clinical #Video #Chest #PhysicalExam #Epigastric #Veins
