Shock and Volume Responsiveness With Hepatic Metastases: Case Suggestive of IVC Compression Syndrome

Sunday, March 22, 2026

12:15 PM - 1:15 PM Central Time

Location: Connections Central - RST 16

Chineen Shah, MD (he/him/his)

Geisinger Medical Center

Disclosure(s): No relevant financial relationship(s) to disclose.
MS

Meera Shah, MBBS, MD

Radiologist
Medical College Baroda

Disclosure information not submitted.
JS

Jeni Sutariya, MBBS

Physician
Pandit Deendayal Upadhyay Medical College

Disclosure information not submitted.
AS

Aishwarya Shah, n/a

Student
Government Medical College Surat

Disclosure information not submitted.
CM

Carlos Martinez, MD

Resident
Jamaica Hospital Medical Center

Disclosure information not submitted.
JM

Jean Vidaillet Martinez, MD

Resident
Jamaica Hospital Medical Center

Disclosure information not submitted.
MR

Matthew Roland, MS

Biostatistician
Jamaica Hospital Medical Center

Disclosure information not submitted.
GF

Grace Pena Fatule, MD

Pulmonary and Critical Care Medicine
Jamaica Hospital Medical Center

Disclosure information not submitted.
KG

Khalid Gafoor, MD

Pulmonary and Critical Care Medicine
Jamaica Hospital Medical Center

Disclosure information not submitted.
NG

Natasha Garg, N/A

MD
Jamaica Hospital

Disclosure information not submitted.

Introduction: Inferior vena cava syndrome (IVCS) is a rare but critical condition, often due to external compression from intra-abdominal malignancies. It leads to impaired venous return, preload depletion, and hemodynamic instability. Diagnosis is typically clinical, supported by imaging and point of care ultrasound (POCUS), and is often underrecognized in critically ill patients.

Description: 57 year old woman with diabetes and recurrent pyelonephritis presented with hypotension, encephalopathy, jaundice, hepatomegaly, bilateral lower extremity edema after recent hospitalization in Ghana. Labs showed leukocytosis, elevated liver enzymes, Acute kidney injury, lactic acidosis. CT and MRI revealed massive hepatomegaly with innumerable hepatic lesions, a large ovarian teratoma, and mass effect on the portal vein. POCUS showed a collapsed IVC and hyperdynamic LV. She remained fluid responsive but vasopressor dependent. Blood cultures were negative, but urine grew ESBL E. coli. Despite broad-spectrum antibiotics, she deteriorated with respiratory failure and died from multiorgan failure.

Discussion: This case shows the clinical impact of IVC compression from hepatic metastases. Her persistent hypotension, fluid dependence, and ultrasound findings (collapsed IVC, kissing ventricles) suggested impaired venous return despite no cardiac or obstructive etiology. Imaging supported extrinsic mass effect on vascular structures. IVC stenting was deferred due to instability. In advanced malignancy, mechanical venous obstruction may worsen septic or hypovolemic shock. Recognition of preload dependence via bedside ultrasound can guide management, even when definitive intervention isn’t feasible.