Multiplanar imaging of inferior vena cava variants

Bilateral duplicated inferior vena cava associated with aberrant internal iliac and gonadal veins: A case-based narrative review

BACKGROUND

The left side anterior retroperitoneal approach is preferred for the management of lumbosacral spine disorders as there is reduced risk for vascular injury. The presence of multiple and uncommon venous variations on either side of the spine, like the bilateral duplicated inferior vena cava (DIVC), may complicate surgery in this region. The current study describes two rare cases of bilateral duplicated inferior vena cava associated with internal iliac and gonadal veins.

METHODS

The cases were identified during routine human dissections of the posterior abdominal wall of 89 (45 males, 44 females) individuals. The course, relations and morphometry of each duplicated inferior vena cava were examined and recorded.

RESULTS

Two (2.2%) of the 89 (1 male, 1 female) dissected individuals showed the presence of bilateral duplicated infrarenal segments of the inferior vena cava. In both cases, the pre-aortic trunk (vein) was the largest and the left inferior vena cava was the smallest. Both cases of bilateral DIVC presented with anomalous interiliac communicating veins, internal iliac veins, and drainage sites of the left gonadal veins.

CONCLUSIONS

The duplicated inferior vena cava may present with associated venous anomalies like those related to the gonadal and internal iliac veins. Knowledge of the duplicated inferior vena cava and its associated venous anomalies may be essential for accurately identifying and diagnosing vascular dysfunction and improving radiological interpretation across multiple surgical specialities.

A unique case of hypoplastic inferior vena cava leading to bilateral iliofemoral venous outflow obstruction and review of literature

Venous thromboembolism (VTE) is a common cardiovascular disease associated with high rates of morbidity and mortality whereas it induces substantial health care costs and increased use of resources. The current standard of treatment for acute deep vein thrombosis (DVT) is anticoagulation, although revascularization can be considered in younger patients with severe symptoms and extensive thrombus burden to prevent long-term sequalae of VTE (eg, recurrent DVTs, post-thrombotic syndrome post-pulmonary embolism syndrome, and chronic thromboembolic pulmonary hypertension). A rare cause of VTE is anomalous development of the inferior vena cava (IVC) and can challenge endovascular revascularization. This case report describes a case of hypoplastic supra hepatic IVC, associated with distal IVC occlusion and bilateral lower extremity DVTs treated successfully with suction thrombectomy and on table only thrombolysis, avoiding the higher risk for major bleeding, intensive care unit admission and prolonged hospitalization associated with prolonged tissue plasminogen activator infusion.

Inferior Vena Cava Anomalies with Portal Vein System Continuation Presenting as Portal Hypertension with a Long-term Follow-up

Inferior vena cava (IVC) anomalies, such as the absence of an intra-hepatic IVC or IVC hypoplasia, are rare. Usually, these anomalies are asymptomatic and cause few clinical issues. We herien report a 53-year-old woman with IVC anomalies who demonstrated both azygos and portal vein system continuation. Over time, this resulted in gradually progressive portal hypertension due to abnormal hemodynamics. The increased inflow from the IVC to the portal vein system for an extended time may contribute to the development of portal hypertension without liver cirrhosis.

Azygos and hemiazygos continuation: An occasional finding in emergency department

Interruption of the inferior vena cava (IVC) with azygos continuation is a rare congenital anomaly, in which the IVC is interrupted below the hepatic vein and venous return beyond this point is restored by the dilated azygos and hemiazygos veins draining into the superior vena cava. A case of the interruption of the IVC with azygos/emyazygos continuation for the absence of the hepatic segment of IVC, left renal vein duplication, and polysplenia is reported. The embryologic, clinical, and radiological significance are discussed.

The diagnosis is suggested by X-ray, but contrast-enhanced multidetector computed tomography is the method of choice to diagnose this venous anomaly and reveals the aberrant vascular structures.

Awareness of different congenital anomalies of IVC is important to surgeons and cardiologists and is necessary for radiologists to avoid diagnostic pitfalls and for preoperative planning: they should be remembered because they can influence several surgical interventions and endovascular procedures. Accidental ligation of the azygos vein is fatal and cardiac catheterization using the lower extremity vein is troublesome in patients with this condition.

Anomalous development of the inferior vena cava: Case reports of agenesis and hypoplasia

We reported the cases of two adult male patients who were admitted to our emergency room with abdominal pain and dyspnea caused by gallstones and pulmonary embolism respectively. During the radiological investigations, as collateral findings, we found two anomalous development of the inferior vena cava. These conditions affect about 4% of population and, although asymptomatic or mildly symptomatic, are associated with thrombotic manifestations as deep vein thrombosis and pulmonary embolism. The prompt recognition of these anomalies is necessary in order to prevent the complications associated with these conditions and to set the best therapy for patients.

Multiplanar Computed Tomography of Vascular Etiologies of Acute Abdomen: A Pictorial Review

Acute abdomen is a common presentation in the emergency department and radiologic imaging plays a pivotal role in the evaluation of such patients. Multi-detector computed tomography (MDCT) is the most commonly utilized radiologic investigation in such patients as it can be performed fairly rapidly and has excellent accuracy for diagnosing various causes of an acute abdomen. Additionally, MDCT may also reveal clues towards an alternative diagnosis that was not even suspected on the basis of a history and physical examination. Consequently, it is indispensable for radiologists to be able to accurately and efficiently recognize imaging features of disorders that may present as an acute abdomen. While gastrointestinal, hepatobiliary and genitourinary causes account for most cases of acute abdomen, vascular etiologies may also be implicated in a small-but significant-proportion of cases. Therefore, in this pictorial review, we describe the typical MDCT imaging features of various vascular etiologies that may present as an acute abdomen.

Anatomic and Technical Considerations: Inferior Vena Cava Filter Placement

Inferior vena cava (IVC) filters play an important role in preventing pulmonary embolism in patients with deep venous thrombosis. When preparing for IVC filter placement, there are several important anatomic and technical considerations. The IVC has complex embryologic origins, and normal variants are relatively common which may necessitate a change in technique or approach. When performing the procedure, the choice in imaging modality for deployment, location of deployment, and route of access must be considered. The pediatric and pregnant populations present unique situations that require special consideration and close examination of indications and contraindications.