Dependent layering of venous refluxed contrast: A sign of critically low cardiac output

Abstract Mortality associated with cardiogenic shock can reach 80%. Although most often diagnosed clinically, the hemodynamics of cardiogenic shock may manifest on contrast-enhanced computed tomography as dependent layering of contrast within the inferior vena cava (IVC), a finding referred to as the “IVC level sign.” Herein we present 2 cases of the IVC level sign. Swift recognition of the IVC level sign and awareness of its dire prognostic implications is essential for achieving the best patient outcomes.