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Imaging suggested possible idiopathic inferior vena cava (IVC) compression, where the IVC was pinched between the right kidney and a tortuously positioned aorta when lying on his left side, exacerbating symptoms. The patient\u2019s blood pressure changed with position (seated: 155\/92\u2009mm Hg, supine: 149\/84\u2009mm Hg, left lateral: 130\/63\u2009mm Hg), indicating positional effects on IVC compression. While IVC compression is typically relieved by a left lateral position in pregnant women, this patient\u2019s symptoms worsened in that position due to unique anatomical variations. This case emphasises the importance of considering positional changes in the differential diagnosis of unexplained hypotension, particularly in patients without typical risk factors.<\/jats:p>","DOI":"10.1136\/bcr-2024-263832","type":"journal-article","created":{"date-parts":[[2025,8,12]],"date-time":"2025-08-12T02:30:16Z","timestamp":1754965816000},"page":"e263832","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Management of possible idiopathic inferior vena cava compression during stereotactic body radiation therapy for lung cancer"],"prefix":"10.1136","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0176-9570","authenticated-orcid":false,"given":"Shinya","family":"Neri","sequence":"first","affiliation":[{"name":"Radiation Oncology, Seirei Hamamatsu Byoin, Hamamatsu, Shizuoka, Japan"},{"name":"Hamamatsu University School of Medicine, Hamamatsu, Shizuoka Prefecture, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuma","family":"Ichikawa","sequence":"additional","affiliation":[{"name":"Radiation Oncology, Seirei Hamamatsu Byoin, Hamamatsu, Shizuoka, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,8,11]]},"reference":[{"key":"2025082702572034000_18.8.e263832.1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2017.74.9671"},{"key":"2025082702572034000_18.8.e263832.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.prro.2017.04.014"},{"key":"2025082702572034000_18.8.e263832.3","doi-asserted-by":"crossref","first-page":"1033","DOI":"10.1080\/17476348.2023.2284362","article-title":"Role of radiation in oligometastases and oligoprogression in metastatic non-small cell lung cancer: consensus and controversy","volume":"17","author":"Kumar","year":"2023","journal-title":"Expert Rev Respir Med"},{"key":"2025082702572034000_18.8.e263832.4","doi-asserted-by":"crossref","first-page":"995","DOI":"10.1007\/s11604-022-01323-9","article-title":"Stereotactic body radiation therapy for metastatic lung metastases","volume":"40","author":"Kimura","year":"2022","journal-title":"Jpn J Radiol"},{"key":"2025082702572034000_18.8.e263832.5","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1016\/j.semradonc.2022.11.007","article-title":"Radiotherapy for Lung Metastases: Conventional to Stereotactic Body Radiation Therapy","volume":"33","author":"Das","year":"2023","journal-title":"Semin Radiat Oncol"},{"key":"2025082702572034000_18.8.e263832.6","unstructured":"UICC . 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