title: The role of inferior vena cava diameter in the differential diagnosis of dyspneic patients; best sonographic measurement method?
abstract: OBJECTIVE
  We aimed to determine the role of inferior vena cava (IVC) diameter in making a differentiation between dyspnea of cardiac (acute heart failure [AHF]) and pulmonary origin. We also attempted to determine the best sonographic method for the measurement of IVC diameter.
  
  
  METHODS
  This prospective observational study was conducted at the intensive care unit of the emergency department of a training and research hospital. This study enrolled patients with the main symptom of dyspnea who were categorized into 2 groups, cardiac dyspnea and pulmonary dyspnea groups, based on the final diagnosis. All patients underwent sonographic measurement of minimum and maximum diameters of IVC, and the caval index (CI) was calculated in both M-mode and B-mode. The sensitivity, specificity, and likelihood ratios (LR) of the IVC values for the differentiation of the 2 groups were calculated.
  
  
  RESULTS
  This study included a total of 74 patients with a mean age of 72.8 years. Thirty-two patients had dyspnea of cardiac origin, and 42 patients had dyspnea of pulmonary origin. The IVC diameter measured with B-mode during inspiration (B-mode i) was the most successful method for differentiation of the 2 groups. B-mode i values greater than 9 mm predicted dyspnea of cardiac origin with a sensitivity of 84.4% and a specificity of 92.9% (+LR: 11.8, LR: 0.16).
  
  
  CONCLUSIONS
  Sonographic assessment of the IVC diameter may be used as a rapid, readily, nonexpensive, complication-free, and reproducible technique for the differentiation of cardiac and pulmonary causes of dyspnea. B-mode i measurement may be more successful in the differentiation of dyspnea compared with other IVC diameters and calculations.
authors.affiliation: Haseki Training and Research Hospital, İstanbul, Turkey. Electronic address: adnanyaman29@gmail.com.
authors.forename: Adnan
authors.initials: A
authors.lastname: Yamanoğlu
authors.affiliation: Beykoz State Hospital, İstanbul, Turkey.
authors.forename: Nalan G
authors.initials: NG
authors.lastname: Çelebi Yamanoğlu
authors.affiliation: İzmir Bozyaka Training and Research Hospital, İzmir, Turkey.
authors.forename: İsmet
authors.initials: İ
authors.lastname: Parlak
authors.affiliation: İzmir Bozyaka Training and Research Hospital, İzmir, Turkey.
authors.forename: Pelin
authors.initials: P
authors.lastname: Pınar
authors.affiliation: Şanlıurfa Mehmet Akif Ersoy Training and Research Hospital, Şanlıurfa, Turkey.
authors.forename: Ali
authors.initials: A
authors.lastname: Tosun
authors.affiliation: İzmir Bozyaka Training and Research Hospital, İzmir, Turkey.
authors.forename: Burak
authors.initials: B
authors.lastname: Erkuran
authors.affiliation: Gaziantep Dr. Ersin Arslan State Hospital, Gaziantep, Turkey.
authors.forename: Alper
authors.initials: A
authors.lastname: Akgür
authors.affiliation: İzmir Bozyaka Training and Research Hospital, İzmir, Turkey.
authors.forename: Neslihan
authors.initials: N
authors.lastname: Satılmış Siliv
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D003937:Diagnosis, Differential; D018450:Disease Progression; D004417:Dyspnea / Q000209:etiology*; D004452:Echocardiography; D004636:Emergency Service, Hospital; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D009929:Organ Size; D011014:Pneumonia / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging; D011655:Pulmonary Embolism / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging; D012680:Sensitivity and Specificity; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging* / Q000473:pathology
chemical_list: D020097:Natriuretic Peptide, Brain