Congenital anomalies of the inferior vena cava: embryogenesis and MR features

Magnetic resonance imaging and clinical findings in seminal vesicle pathologies

PURPOSE

Congenital and acquired pathologies of the seminal vesicles (SV) are rare diseases. The diagnosis of SV anomalies is frequently delayed or wrong due to the rarity of these diseases and the lack of adequate evaluation of SV pathology. For this reason, we aimed to comprehensively evaluate SV pathologies and accompanying genitourinary system abnormalities.

MATERIALS AND METHODS

Between March 2012 and December 2015, 1455 male patients with different provisional diagnosis underwent MRI. Congenital and acquired pathology of the SV was identified in 42 of these patients. The patients were categorized according to their SV pathologies. The patients were analyzed in terms of genitourinary system findings associated with SV pathologies.

RESULTS

SV pathologies were accompanied by other genitourinary system findings. Congenital SV pathologies were bilateral or predominantly in the left SV. Patients with bilateral SV hypoplasia were diagnosed at an earlier age compared to patients with unilateral SV agenesis. There was a significant association between abnormal signal intensity in the SV and benign prostate hypertrophy (BPH) and patient age.

CONCLUSION

SV pathologies are rare diseases of the genitourinary system. The association between seminal vesicle pathology and other genitourinary system diseases requires complete genitourinary system evaluation that includes the seminal vesicles.

Left transperitoneal laparoendoscopic single-site radical nephrectomy in the presence of a duplicated inferior vena cava with associated complex renal vascular anomalies

Laparo-endoscopic single-site (LESS) renal surgery is steadily gaining momentum. LESS by itself is technically challenging, with a potentially increased procedural risk, and the presence of major vascular anomaly may increase the risk of intraoperative mishap. Here we present a case of left transperitoneal LESS radical nephrectomy that was successfully performed in the presence of double inferior vena cava with associated complex renal vascular anomalies. What is more important is to bring such an aberrant vascular anatomy to the attention of laparoscopic, especially LESS, surgeons.

Duplication of the inferior vena cava

We highlight the case of a double Inferior Vena Cava (IVC) encountered in a multi-visceral recovery operation on a deceased donor. In such cases pre-operative abdominal cross sectional imaging is usually not available hence the procurement surgeon needs to rely on vigilance and awareness of other potential anatomical variations that are associated with the condition. We outline our operative approach, summarize the embryological development of IVC and present the case as a reminder of this rare anatomical variation.

Extra-adrenal retroperitoneal paraganglioma associated with duplication of inferior vena cava

Retroperitoneal paragangliomas arise from specialized neural crest cells symmetrically distributed along the aorta in association with the sympathetic chain. If this tissue aggregates in the adrenal medulla pheochromocytoma may arise. When it remains in the paraaortic sites it could develop into extra-adrenal, retroperitoneal paraganglioma. We report a case of extra-adrenal paraganglioma in the renal hilum intimately related to the left side of a double inferior vena cava. To the best of our knowledge such an association has never been described before. The clinical significance of this venous anomaly is reviewed.

Duplication of the inferior vena cava associated with other variations

Multiple vascular variations, including duplication of the inferior vena cava, double renal arteries and anomalies of the testicular blood vessels, were observed during dissection of the retroperitoneal region of a cadaver of an 87-year-old Japanese man. The right inferior vena cava arose from the union of right common iliac veins and a thinner interiliac vein. This interiliac vein ascended obliquely from right to left and joined the left common iliac veins to form the left inferior vena cava. The right and left inferior venae cavae were of approximately equal width. The right testicular vein consisted of medial and lateral venous trunks. The two venous trunks coalesced to form a single vein, which drained into the confluence of the right inferior vena cava and right renal vein. The left testicular vein was composed of the medial and lateral testicular veins, which drained into the left renal vein. Double renal arteries were seen bilaterally, which originated from the lateral aspects of the abdominal aorta. The right testicular artery arose from the right inferior renal artery and accompanied the lateral trunk of the right testicular vein running downwards. The left testicular artery arose from the ipsilateral inferior renal artery and ran downwards accompanied by the left lateral testicular vein. In addition, the bilateral kidneys showed multicystic changes.

Primary Budd-Chiari syndrome: outcome of endovascular management for suprahepatic venous obstruction

OBJECTIVE

Primary Budd-Chiari syndrome (BCS) is a rare form of hepatic venous outflow obstruction at the suprahepatic inferior vena cava (IVC), the hepatic veins, or both. We assessed our 4-year experience in the management of BCS to evaluate the results of our methods of care.

METHODS

We conducted a retrospective review of a nonrandomized clinical trial conducted in three teaching hospitals. Among 28 primary BCS patients, 9 remained in medical treatment only, and 19 who failed to respond to medical treatment received additional endovascular (n = 17) or surgical therapy (n = 2). Nine underwent IVC balloon angioplasty alone, 6 had angioplasty plus stents, and 2 had transjugular intrahepatic portosystemic shunts (TIPS) for hepatic vein lesions. One patient had a mesoatrial bypass; another had liver transplantation. Immediate response to the therapy was assessed with angiography and ultrasonography based on anatomic and/or hemodynamic correction or reduction of the lesion. Subsequent assessment of portal hypertension status was made with periodic clinical and laboratory evaluation (eg, ultrasonography, liver biopsy).

RESULTS

Twenty-six patients had had IVC stenosis or occlusion by focal or segmental lesion. Two patients had hepatic vein outlet obstruction. There was no evidence of coagulopathy as the pathogenesis; all were related to membranous obstruction of the vena cava. Excellent immediate response to the endovascular therapy and subsequent relief of portal hypertension were achieved in 14 patients. Four patients had restenosis or progression of the residual lesion within 2 years; three responded to repeated stenting. Primary patency was 76.5%, and primary assisted patency was 94.1%. Two patients with TIPS and two with surgical therapy maintained excellent results. The medical treatment remained effective only in a limited group of 6 (21.4%) of the 28 patients.

CONCLUSIONS

In BCS, both endovascular and surgical interventions provide excellent results and potentially halt liver parenchymal deterioration caused by portal hypertension. Liver transplantation remains the ultimate solution for advanced liver failure.

Three-dimensional contrast-enhanced magnetic resonance angiography of congenital inferior vena cava anomalies

BACKGROUND/PURPOSE

Congenital anomalies of the inferior vena cava (IVC) are infrequent conditions. Most are asymptomatic and incidentally discovered. However, their recognition may sometimes have relevant clinical and therapeutic implications. The purpose of this report is to emphasize the importance of accurate identification and to assess the utility of three-dimensional contrast-enhanced magnetic resonance angiography (3D contrast-enhanced MRA) in their evaluation.

METHODS

We retrospectively evaluated the 3D contrast-enhanced MRA of 21 patients in whom an IVC anomaly was found.

RESULTS

Five of these anomalies concerned the hepatic and prerenal segments, seven were located in the renal segment, and finally, the last nine concerned the postrenal segment.

CONCLUSION

IVC anomalies are uncommon conditions which may sometimes have important clinical implications. 3D contrast-enhanced MRA is a good method not only to identify them, but also to depict them accurately and safely.

Anatomic basis of minimal anterior extraperitoneal approach to the lumbar spine

Anterior lumbar spine approaches may be indicated for fusion in degenerative lumbar spine disorders or to fill discal and bone gaps after fracture reduction. We present an anterior extraperitoneal approach applicable to any discal and vertebral levels from T12 to S1. The anatomic study, based on 25 cadavers, highlights retroperitoneal dissection principles for easy kidney and duodenopancreatic mobilisation and direct left anterior access to the entire lumbar spine. We established a precise description of the lumbar veins and the anastomoses between the left renal vein and hemiazygos system, in order to define different topographic and anatomic factors related to safe and easily reproducible approaches for cage or graft implementation. Independent of the level and previous intraperitoneal surgery, lumbar spine access with this approach safeguards the kidney, ureter, spleen, hypogastric plexus and duodenopancreatic system. Regarding operating time, blood-loss and possibilities for freshening and grafting, this technique seems an effective counterbalance to the difficulties and complex technology of endoscopic approaches. The clinical study includes our first 42 cases in traumatic and degenerative lesions. Avoiding the neurologic or hemorrhagic risk inherent in classical posterior lumbar interbody fusion (PLIF) techniques, it can be considered as a reasonable and valid alternative. This technique could be used in the near future for mini invasive discal prosthesis insertion.

Anomalies of the inferior vena cava and renal veins: embryologic and surgical considerations

Anomalies of the inferior vena cava and renal veins occur infrequently but if unidentified can lead to significant morbidity during surgical exploration. An understanding of the embryologic development of the vena cava and its tributaries is necessary to understand the genesis of these sometimes complex anomalies and their accompanying anatomic variants. Newer radiologic modalities in the form of spiral computed tomography (CT) and three-dimensional reconstruction of spiral CT allow clear definition of the anatomy of these anomalies. Variations in the embryologic evolution of the vena cava dictate the different venous anomalies that may be encountered in the retroperitoneum. Additionally, the utility of newer radiologic modalities in the identification of these anomalies is discussed.

"Marsupial cava" and ruptured abdominal aortic aneurysm. A case report and review of the literature

A patient with a ruptured abdominal aortic aneurysm underwent an emergency operation. A rare anomaly of inferior vena cava, known as "marsupial cava," was found. The iliac vein confluence crossed anteriorly (rather then posteriorly) the right common iliac artery. Even though the patient had undergone a computed tomography scan, this rare anomaly had not been detected and therefore was unexpected by the surgeon. The aim of this report is to describe the technical details required to perform the aortic reconstruction and to stress the importance of routine computed tomography scans and their careful reading in the case of stable patients before retroperitoneal operation. This is, to our knowledge, the first report of an aortic prosthetic grafting for ruptured aortic aneurysm in association with a marsupial cava.

Intra- and infrahepatic agenesis of the inferior vena cava with azygos continuation accompanied by duplication of the postrenal segment

Agenesis of one or more segments and duplication of the infrarenal segment are, individually, rare abdominal variants of the inferior vena cava (IVC). In this article, the authors report on a case in which these two anomalies occurred concurrently. Details of the embryology are presented insofar as they are necessary for an understanding of this IVC variant. Spiral computed tomography makes it possible to define the vascular morphology and to make a differentiation from lymphadenopathy. Cavography gives an overall picture of the vascular morphology.

Anomalous inferior and superior venae cavae with oculoauriculovertebral defect: review of Goldenhar complex and malformations of left-right asymmetry

We observed a girl with an interrupted, left inferior vena cava with hemiazygous continuation, bilateral superior venae cavae, heart defects, and sacral agenesis. She had macrostomia and bilateral ear tags and pits, as in oculoauriculovertebral defect. Maternal diabetes was present. The combination, which we call OAV-heterotaxia complex, supports the view that some cases of oculoauriculovertebral defect may be part of a midline field defect of blastogenesis.

Magnetic Resonance Imaging of Deep Venous Thrombosis with Anomalous Inferior Vena Cava

Design:

Case report.

Setting:

Leicester Royal Infirmary.

Patients:

A 17-year-old male patient presenting with postoperative deep venous thrombosis secondary to anomalous inferior vena cava.

Interventions:

Imaging to establish the diagnosis, anticoagulation and follow-up.

Main outcome measures:

Serial magnetic resonance imaging and the clinical condition of the patient were assessed.

Results:

The patient made a good recovery and did not require a laparotomy.

Conclusions:

Magnetic resonance imaging is very useful in the detection of central deep venous thrombosis and anomalous inferior vena cava and should be considered in young patients with postoperative deep venous thrombosis.

Anomalous inferior vena cava associated with horseshoe kidneys

Two cases are presented in which anomalies of the inferior vena cava were associated with horseshoe kidneys. Radiological demonstration of such combined variation is rare, only one case of duplicated inferior vena cava with horseshoe kidney having been found in the literature. The embryological basis for these anomalies is reviewed. A possible explanation for their coexisting occurrence is also speculatively raised.

Duplication of inferior vena cava: its importance in retroperitoneal surgery

Anomalies of the inferior vena cava arise infrequently. Knowledge of their presence can be established preoperatively with a variety of radiologic studies. This knowledge can prevent hemorrhagic complications from occurring during surgery. We present a case report of a patient with renal cell carcinoma and duplication of the inferior vena cava.