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 Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 13  |  Issue : 2  |  Page : 94-98

B-mode ultrasonographic measurement of inferior vena cava diameter among healthy adults in Kano, Nigeria


Department of Radiology, Aminu Kano Teaching Hospital, Kano State, Nigeria

Date of Web Publication1-Aug-2016

Correspondence Address:
Abdu Hamisu Dambatta
Department of Radiology, Aminu Kano Teaching Hospital, Kano State
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0331-8540.181232

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  Abstract 

Background: The inferior vena cava (IVC) is thin-walled compliant vessel that adjust the body volume status by changing its diameter depending on the total body fluid volume. sonographic measurement of IVC diameter has been reported as an alternative, rapid and non-invasive method of volume assessment of body fluids. The aim of this study is to determine the normal IVC diameter among healthy adults in Kano, Nigeria. Materials and Methods: Sonographic measurement of IVC of healthy adults with age ranging between 15 and 65 years was done with the subject in the supine position. The intrahepatic portion of its diameter was measured at about 2 cm proximal to the hepatic veins in a longitudinal plane in both inspiratory and expiratory phases of respiration. Three repeated measurements were done to reduce intra-observer variability in this prospective cross-sectional study. Results: A total of 400 adults comprising 173 (43.3%) males and 227 (56.8%) females were recruited using Fisher's statistical formula for sample size determination. The mean age of the subjects was 32.4 ± standard deviation 10.9 years. The mean inspiratory diameter was 10.1 ± 2.7 mm (ranging from 4.8 mm to 18.8 mm). The overall mean IVC expiratory (IVCexp) diameter in this study was 16.7 ± 2.7 mm (range = 10.9–25.4 mm). The mean IVCexp diameter was slightly higher for males than for females (males: 17.1 ± 2.8 mm; females: 16.3 ± 2.7 mm). This difference was statistically significant (P = 0.0022). There was a gradual decrease in IVC diameter with advancing age. Conclusion: This study was able to generate normal IVC diameter in a sample of Nigerians which may serve as a reference for normal values in Black Africans.

Keywords: B-mode, inferior vena cava diameter, ultrasonography


How to cite this article:
Dambatta AH. B-mode ultrasonographic measurement of inferior vena cava diameter among healthy adults in Kano, Nigeria. Niger J Basic Clin Sci 2016;13:94-8

How to cite this URL:
Dambatta AH. B-mode ultrasonographic measurement of inferior vena cava diameter among healthy adults in Kano, Nigeria. Niger J Basic Clin Sci [serial online] 2016 [cited 2019 May 21];13:94-8. Available from: http://www.njbcs.net/text.asp?2016/13/2/94/181232


  Introduction Top


The inferior vena cava (IVC) is a thin-walled compliant vessel that adjust the body volume status by changing its diameter depending on the total body fluid volume.[1],[2] The vessel contracts and expands with inspiration and expiration, respectively. The negative pressure created by the inspiration increases venous return to the heart, briefly collapsing the IVC. Expiration decreases venous return and the IVC returns to its baseline diameter. The difference between the IVC expiratory (IVCexp) and IVC inspiratory (IVCinsp) diameter is regarded as collapsibility [3] and collapsibility index is defined as IVCexp – IVCinsp/IVCexp. The index reflects the elasticity of IVC as the capacitance vessel.

An accurate assessment of the body fluid status is a significant challenge during every clinical examination.[4] The routine physical examination provides a useful, but the imprecise picture of fluid status.[5] Invasive methods for assessment of volume status include the placement of central venous or pulmonary arterial catheter for measurement of central venous pressure. These have obvious disadvantages including of delay in placement and potential complications.[6]

Sonographic measurement of IVC diameter has been reported as an alternative, rapid and non-invasive method of volume assessment of body fluids.[7],[8],[9],[10],[11],[12]

The aim of this study was to determine the normal IVC diameter among healthy adults in Kano, Nigeria.


  Materials and Methods Top


This prospective study was carried out over 1 year period between July 2009 and June 2010 at Radiology Department of Aminu Kano Teaching Hospital, Kano, Nigeria.

The study population consists of healthy volunteered subjects who are ≥15 years of age in ultrasound clinic of the Aminu Kano Teaching Hospital.

Ethical approval was obtained from the Ethical Committee of AKTH, Kano and informed consent was also obtained from the subjects before the ultrasound scanning. The ultrasound study of the IVC was conducted using 3.5 MHz curvilinear transducer of the Mindray DP 8800 ultrasound machine (Shenzhen, China).

The longitudinal image of the hepatic portion of the IVC was obtained through windows in the right subcostal space. It was measured about 2 cm distal to the entry of hepatic veins. The inspiratory and expiratory diameters of the IVC were measured [Figure 1] and [Figure 2]. The data obtained were analysed using Statistical Package for Social Sciences version 16.0 software for windows (SPSS Inc, IL, Chicago, USA) and Minitab version 16.1 (Minitab, 2010, Pennsylvania, USA) statistical software. Results were expressed as the mean/standard deviation (SD) and or median with ranges as appropriate. Comparison of mean and proportion was considered significant at P < 0.05. Findings have been presented in the form of summarised numerical, graphical and tabular forms.
Figure 1: Longitudinal image of abdominal scan showing measurement of expiratory diameter of inferior vena cava (arrows)

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Figure 2: Longitudinal image of abdominal scan showing measurement of inspiratory diameter of inferior vena cava (arrows)

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  Results Top


A total of 400 consecutive subjects comprising 173 (43.3%) males and 227 (56.8%) females were recruited for this study [Figure 3] and [Table 1].
Figure 3: Pie chart showing sex distribution of the subjects

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Table 1: Sex distribution of subjects with mean inferior vena cava diameter

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The mean age for the subjects was 32.4 ± SD 10.8 years (range: 15–65 years). The majority (36.4%) are in the age range of 25–34 years [Table 2].
Table 2: Age groups of the subjects with percentages

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The mean age of males was 35.3 ± 12.4 years and that of females was 30.2 ± 9.0 years. The overall mean IVCexp diameter in this study was 16.7 ± 2.7 mm (range: 10.9–25.4 mm).

The mean IVCexp diameter was slightly more for males than females (males: 17.1 ± 2.8 mm; females: 16.3 ± 2.7 mm). This difference was statistically significant (P = 0.0022).

There was a gradual decrease in IVC diameter with advancing age [Table 3] and [Figure 4].
Table 3: Inferior vena cava diameter of the age groups

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Figure 4: Linear graph showing relationship of age and inferior vena cava diameter

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  Discussion Top


The IVC is a thin-walled compliant vessel that adjusts to the body's volume status by changing its diameter depending on the total body fluid volume. The vessel contracts and expands with each respiration. The negative pressure created by the inspiration increases venous return to the heart, briefly collapsing the IVC. Expiration decreases venous return and the IVC returns to its baseline diameter.[1] The difference between the IVCexp and IVCinsp diameter is regarded as collapsibility, and collapsibility index [2] is defined as IVCexp – IVCinsp/IVCexp. The index reflect the elasticity of IVC as the capacitance vessel.[13],[14],[15]

The objective of the present work was to analyse the measurement of IVC diameter in healthy adults of both sexes, with special attention on the influence of age and sex.

The absolute measure of IVC diameter is often made at the maximal expiration, although some have used inspiratory diameter, and many studies do not specify.[16] In this study, the expiratory diameter was used as the absolute value of IVC diameter.

In healthy individuals, the IVCexp diameter ranges from 15 mm to 20 mm and the IVCinsp diameter from 0 mm to 14 mm.[16] In this study, the overall mean IVCexp diameter was 16.7 mm. This showed that the value is within normal range.

However, in a study by Lyon et al.[17] involving healthy blood donors, the mean IVC diameter before the donation was 17.4 mm (ranging from 15.2 mm to 19.7 mm). This difference could probably be explained due to geographical variation.

Chuo et al.[18] in a study involving 48 healthy adults (23 males and 25 females) and consisting of three ethnic groups (Malay, Chinese and Indian) found that there was no significant difference between sex, age and ethnic groups in the diameter of IVC. However, this study consisting of 400 subjects showed that the mean IVCexp diameter for males was 17.1 ± 2.8 mm and for females was 16.3 ± 2.7 mm.

This, therefore, shows that the mean IVC diameter for males was higher than that of the females (P < 0.0022) and hence, IVC diameter varies with sex in our environment. The difference could be explained possibly due to small sample size in the above study which may statistically affect the findings.

Mandelbaum and Ritz [19] compared IVC diameter among normal subjects and dialysis patients. The study found that in 86 normal control subjects (age 18–76 years), IVC diameter showed a wide variation, and it is not correlated to age, height, weight or body surface area. However, a negative correlation between age and IVC diameter was observed in this study. The initial increase in mean IVC diameter was noted with age from15 to 24 years age group up to 35–44 years age group with the mean IVC diameter at 15–24 years age group being 16.6 mm and at 35–44 years age group being 16.8 mm [Table 1]. After that, a decline in IVC diameter was noted. A similar decrease in IVC diameter was noted from 35 to 44 years age group in both male and female age groups respectively. The difference with their study could also be possibly due to small sample size which may statistically affect the findings. Although Masugata et al.[20] employed the echocardiographic technique in individuals aged 17–94 years, they found a similar decrease in maximal diameter of IVC with advancing age.

However, the measurement of IVC diameter in all studies has not been done using a universal method. The locations of IVC measurements differ across studies.[21] Lyon et al.[17] used 2 cm distal of the IVC – hepatic vein junction similar to what was used in the present study. However, Feissel et al.[22] used approximately 3 cm from the right atrium. Some sonologists advocate the use of M-mode (motion mode) to calculate IVC dimensions during the respiratory cycle.[17] Although M-mode does allow for superior temporal resolution in real time when compared to B-mode, this, however, results in potentially inaccurate measurements, as the natural movement of the diaphragm during respiration results in caudal displacement of the IVC and in effect, measurement of two different locations during inspiration and expiration. The use of B-mode measurements ensures that the IVC dimensions are calculated at the same cranial-caudal level throughout the respiratory cycle.


  Conclusion Top


IVC diameter in a sample of Nigerians has been used to provide a reference value. The range of IVC diameters was slightly lower than that of Caucasians, and there was a decrease in IVC diameter with advancing age. The average IVC diameter was also higher in males than females. These results support earlier reports that normal value for each region be estimated separately due to geographic and racial differences. Further research in the Nigerian environment is necessary to validate the results obtained from this study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Goldflam K, Saul T, Lewiss R. Inferior Vena Cava Ultrasound. Available from: http://www.acep.org/content.aspx?id=80791. [Last retrieved 2016 Jan 08].  Back to cited text no. 1
    
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3.
Sefidbakht A, Assadsangabi A, Nabavizadeh A. Sonographic measurement of the inferior vena cava as a marker of blood loss. Iran J Radiol 2007;4:13-4.  Back to cited text no. 3
    
4.
Kosiak W, Swieton D, Piskunowicz M. Sonographic inferior vena cava/aorta diameter index, a new approach to the body fluid status assessment in children and young adults in emergency ultrasound – preliminary study. Am J Emerg Med 2008;26:320-5.  Back to cited text no. 4
    
5.
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Gillman LM, Ball CG, Panebianco N, Al-Kadi A, Kirkpatrick AW. Clinician performed resuscitative ultrasonography for the initial evaluation and resuscitation of trauma. Scand J Trauma Resusc Emerg Med 2009;17:34.  Back to cited text no. 6
    
7.
Gupta LC, Gupta A. X-ray Diagnosis and Imaging. 3rd ed. Bangalore, Calcutta, Chennai, Mumbai: Jaypee Brothers; 1998. p. 366.  Back to cited text no. 7
    
8.
Kalantari K, Chang JN, Ronco C, Rosner MH. Assessment of intravascular volume status and volume responsiveness in critically ill patients. Kidney Int 2013;83:1017-28.  Back to cited text no. 8
    
9.
Fields JM, Lee PA, Jenq KY, Mark DG, Panebianco NL, Dean AJ. The interrater reliability of inferior vena cava ultrasound by bedside clinician sonographers in emergency department patients. Acad Emerg Med 2011;18:98-101.  Back to cited text no. 9
    
10.
Citilcioglu S, Sebe A, Ay MO, Icme F, Avci A, Gulen M, et al. The relationship between inferior vena cava diameter measured by bedside ultrasonography and central venous pressure value. Pak J Med Sci 2014;30:310-5.  Back to cited text no. 10
    
11.
Kulkarni AP, Janarthanan S, Harish MM, Suhail S, Chaudhari H, Agarwal V, et al. Agreement between inferior vena cava diameter measurements by subxiphoid versus transhepatic views. Indian J Crit Care Med 2015;19:719-22.  Back to cited text no. 11
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Aydin SA, Ozdemir F, Taskin G, Ocakoglu G, Yildirim H, Koksal O. Is there a relationship between the diameter of the inferior vena cava and hemodynamic parameters in critically ill patients? Niger J Clin Pract 2015;18:810-3.  Back to cited text no. 12
[PUBMED]  Medknow Journal  
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Blehar DJ, Dickman E, Gaspari R. Identification of congestive heart failure via respiratory variation of inferior vena cava diameter. Am J Emerg Med 2009;27:71-5.  Back to cited text no. 13
    
14.
Thanakitcharu P, Charoenwut M, Siriwiwatanakul N. Inferior vena cava diameter and collapsibility index: A practical non-invasive evaluation of intravascular fluid volume in critically-ill patients. J Med Assoc Thai 2013;96 Suppl 3:S14-22.  Back to cited text no. 14
    
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Gundersen GH, Norekval TM, Haug HH, Skjetne K, Kleinau JO, Graven T, et al. Adding point of care ultrasound to assess volume status in heart failure patients in a nurse-led outpatient clinic. A randomised study. Heart 2016;102:29-34.  Back to cited text no. 15
    
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Sefidbakht S, Assadsangabi R, Abbasi HR, Nabavizadeh A. Sonographic measurement of the inferior vena cava as a predictor of shock in trauma patients. Emerg Radiol 2007;14:181-5.  Back to cited text no. 16
    
17.
Lyon M, Blaivas M, Brannam L. Sonographic measurement of the inferior vena cava as a marker of blood loss. Am J Emerg Med 2005;23:45-50.  Back to cited text no. 17
    
18.
Chuo LS, Mahmud R, Salih QA. Color Doppler ultrasound examination of the main portal vein and inferior vena cava in normal Malaysian adult population. A fasting and post prandial evaluation. Available from: http://www. Ispub.com/IJCVR/2/2/9055. [Last retrieved on 2016 Jan 01].  Back to cited text no. 18
    
19.
Mandelbaum A, Ritz E. Inferior vena cava diameter measurement for estimation of dry weight in haemodialysis patients. Nephrol Dial Transplant 1996;11 Suppl 2:24-7.  Back to cited text no. 19
    
20.
Masugata H, Senda S, Okuyama H, Murao K, Inukai M, Hosomi N, et al. Age-related decrease in inferior vena cava diameter measured with echocardiography. Tohoku J Exp Med 2010;222:141-7.  Back to cited text no. 20
    
21.
Wallace DJ, Allison M, Stone MB. Inferior vena cava percentage collapse during respiration is affected by the sampling location: An ultrasound study in healthy volunteers. Acad Emerg Med 2010;17:96-9.  Back to cited text no. 21
    
22.
Feissel M, Michard F, Faller JP, Teboul JL. The respiratory variation in inferior vena cava diameter as a guide to fluid therapy. Intensive Care Med 2004;30:1834-7.  Back to cited text no. 22
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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