1
|
Masino F, Muscatella G, Montatore M, Gifuni R, Guglielmi G. A remarkable case report of an interrupted inferior vena cava with hemiazygos and transhepatic continuation. ACTA BIO-MEDICA : ATENEI PARMENSIS 2023; 94:e2023238. [PMID: 37850759 PMCID: PMC10644922 DOI: 10.23750/abm.v94i5.15085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 08/17/2023] [Indexed: 10/19/2023]
Abstract
Inferior vena cava (IVC) interruption with azygos/hemiazygos continuation is an extremely uncommon congenital vascular anomaly, which may present with multiple variants. As a result, it is challenging to find in the literature the same anatomical variant. We report a unique case of an interrupted IVC with hemiazygos and transhepatic continuation in an 83-year-old female patient. The case was evaluated by performing Computed Tomography (CT) as imaging modality, with a multiphase protocol, able to detect accurately this complex vascular anomaly. The purpose of this case report is not only to present this remarkable case but also to briefly show the types of interrupted IVC, starting from the anatomy and the embryology of the IVC and the azygos system, and to discuss the value of imaging in detecting the vascular anomaly.
Collapse
Affiliation(s)
- Federica Masino
- Department of Clinical and Experimental Medicine, Foggia University School of Medicine, Foggia (FG), Italy.
| | - Gianmichele Muscatella
- Department of Clinical and Experimental Medicine, Foggia University School of Medicine, Foggia (FG), Italy.
| | - Manuela Montatore
- Department of Clinical and Experimental Medicine, Foggia University School of Medicine, Foggia (FG), Italy.
| | - Rossella Gifuni
- Department of Clinical and Experimental Medicine, Foggia University School of Medicine, Foggia (FG), Italy.
| | - Giuseppe Guglielmi
- Department of Clinical and Experimental Medicine, Foggia University School of Medicine, Foggia (FG), Italy.
| |
Collapse
|
2
|
Abu-Hilal LH, Barghouthi DI, AbuKeshek T, Tamimi H, Khatib H, Dayeh AH. Interrupted inferior vena cava syndrome discovered incidentally after minimally invasive mitral valve repair in a 31-year-old female patient: A case report. Int J Surg Case Rep 2023; 109:108621. [PMID: 37544095 PMCID: PMC10423890 DOI: 10.1016/j.ijscr.2023.108621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 07/28/2023] [Accepted: 07/31/2023] [Indexed: 08/08/2023] Open
Abstract
INTRODUCTION Femoral cannulation is a technique used in minimally invasive cardiac surgery (MICS) for accessing the heart through the femoral artery and vein. However, the presence of an interruption in the inferior vena cava (IVC) can pose challenges during the procedure. Understanding the patient's venous anatomy is crucial to ensure successful cannulation. PRESENTATION OF CASE We present the case of a 31-year-old female patient scheduled for minimally invasive mitral valve repair. During the procedure, femoral vein cannulation was unsuccessful. Subsequent diagnostic Computed Tomography (CT) revealed an interrupted IVC with azygos continuation. DISCUSSION The interruption of the IVC can make cannulation through the femoral vein difficult or impossible due to the absence of the femoral vein or the presence of a collateral, necessitating alternative approaches. Preoperative imaging, such as CT, plays a significant role in identifying IVC interruptions and guiding surgical planning. CONCLUSION Our case highlights the challenges associated with IVC interruptions during femoral cannulation in MICS. Preoperative imaging is essential for identifying anatomical variations and determining the most appropriate cannulation approach.
Collapse
Affiliation(s)
| | | | - Tawfiq AbuKeshek
- Department of Radiology, Al-Makassed Hospital, Jerusalem, Palestine
| | - Helmi Tamimi
- Department of Cardiac Surgery, Al-Makassed Hospital, Jerusalem, Palestine
| | - Hassan Khatib
- Department of Cardiac Surgery, Al-Makassed Hospital, Jerusalem, Palestine
| | - Abdul-Hakim Dayeh
- Department of Cardiac Surgery, Al-Makassed Hospital, Jerusalem, Palestine
| |
Collapse
|
3
|
Abu Sabha MR, Bairmani ZA, Alfroukh KM, Nassar O, Albakri M. Extensive Deep Vein Thrombosis With Intraabdominal Extension Triggered by Oral Contraceptive Use in a Young Patient With Interrupted Inferior Vena Cava With Azygos Continuation: A Case Report. Cureus 2023; 15:e42690. [PMID: 37649933 PMCID: PMC10465072 DOI: 10.7759/cureus.42690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2023] [Indexed: 09/01/2023] Open
Abstract
Congenital malformations of the inferior vena cava (IVC) are rare and often asymptomatic, typically discovered incidentally during imaging. However, these anomalies can result in circulatory stasis, impede venous return, and serve as predisposing factors for thrombus formation. Here, we present a unique case of a 28-year-old female patient who was found to have interrupted IVC with azygos continuation, an exceedingly rare IVC anomaly, during a work-up of extensive bilateral deep vein thrombosis (DVT) with an intraabdominal extension which was triggered by recent combined oral contraceptive pills (OCP) use. This case highlights the importance of considering vena cava malformations as an underlying cause for extensive DVT, even in the absence of conventional risk factors. Clinicians should be aware of the potential association between congenital vena cava anomalies and thrombotic events, as early recognition and appropriate management are crucial for preventing complications such as pulmonary embolism.
Collapse
Affiliation(s)
- Mosa R Abu Sabha
- Internal Medicine, Faculty of Medicine, Al Quds University, Jerusalem, PSE
| | - Zinah A Bairmani
- Department of Pharmacology & Experimental Therapeutics, Thomas Jefferson University, Philadelphia, USA
| | | | - Osayd Nassar
- Internal Medicine Department, Al-Ahli Hospital, Hebron, PSE
| | - Mutaz Albakri
- Internal Medicine Department, Hebron University College of Medicine, Hebron, PSE
| |
Collapse
|
4
|
Moroi K, Watanabe K, Tabira Y, Iwanaga J, Yamashita A, Han A, Saga T, Yamaki KI. An Extremely Rare Case of Intestinal Malrotation with an Absent Inferior Vena Cava. Kurume Med J 2023; 67:193-199. [PMID: 36464276 DOI: 10.2739/kurumemedj.ms674005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
We present a case of intestinal malrotation with an absent inferior vena cava, which was found in a cadaver during a dissection course in our medical school. The intestinal malrotation was Amir-Jahed type 2, with the large intestine on the right side and the small intestine on the left side of the abdominal cavity. The descending colon was fixed on the right side of the posterior abdominal wall and continued into the pelvic cavity from the right side. The cadaver also had a venous system anomaly. The pre-renal segment of the inferior vena cava, which is a section between the renal vein and the hepatic vein, was absent. The inferior vena cava connected to the azygos vein after being joined by bilateral renal veins. The only hepatic segment of the inferior vena cava, which was posterior to the liver and received hepatic veins, penetrated the diaphragm and flowed into the right atrium. To our knowledge, this is the first report of these two anomalies appearing concurrently. We discuss the details of this case and the embryological considerations.
Collapse
Affiliation(s)
| | - Koichi Watanabe
- Division of Gross and Clinical Anatomy, Department of Anatomy, Kurume University School of Medicine
| | - Yoko Tabira
- Division of Gross and Clinical Anatomy, Department of Anatomy, Kurume University School of Medicine
| | - Joe Iwanaga
- Division of Gross and Clinical Anatomy, Department of Anatomy, Kurume University School of Medicine.,Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University
| | - Akihiro Yamashita
- Division of Gross and Clinical Anatomy, Department of Anatomy, Kurume University School of Medicine
| | - Aya Han
- Division of Gross and Clinical Anatomy, Department of Anatomy, Kurume University School of Medicine
| | - Tsuyoshi Saga
- Division of Gross and Clinical Anatomy, Department of Anatomy, Kurume University School of Medicine
| | - Koh-Ichi Yamaki
- Division of Gross and Clinical Anatomy, Department of Anatomy, Kurume University School of Medicine
| |
Collapse
|
5
|
Kraus M, Tau N. Interrupted inferior vena cava with deep vein thrombosis. BJR Case Rep 2023; 9:20220100. [PMID: 36873229 PMCID: PMC9976716 DOI: 10.1259/bjrcr.20220100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/18/2022] [Accepted: 11/01/2022] [Indexed: 11/11/2022] Open
Abstract
A 22-year-old healthy man presented to the emergency department with worsening left flank and testicular pain. Lower abdominal pain and lower urinary tract symptoms, were also noted. Contrast-enhanced CT demonstrated several vascular malformations: both common iliac veins converging to an infrarenal inferior vena cava (IVC) with an absent cephalad IVC. Multiple collateral veins were noted, and both the Azygos and Hemiazygos veins were seen dilated, serving as an alternative venous drainage path due to the interrupted IVC. The patient's CT was also notable for several pathologies: bilateral iliac vein thrombosis and left-sided testicular vein thrombus with surrounding fat stranding, suggestive of testicular vein thrombophlebitis. The patient was admitted, and received antibiotic and anticoagulation treatment, with clinical improvement. Hypercoagulability work-up was obtained, and the patient was found to be heterozygous for Factor V Leiden. Interrupted IVC with azygos continuation is an uncommon, and mostly a benign vascular malformation, resulting from abnormal development of IVC-contributing segments during embryogenesis. It is associated with lower limb deep vein thombosis and hypercoagulable states. It is imperative for radiologists to be acquainted with this entity, in order to avoid misdiagnosis. Testicular vein thrombosis is uncommon, mostly associated with prothrombotic disorders, and it should be considered when coagulopathy is suspected.
Collapse
Affiliation(s)
- Matan Kraus
- Department of Diagnostic Imaging, Sheba Medical Center, Ramat Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Noam Tau
- Department of Diagnostic Imaging, Sheba Medical Center, Ramat Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
6
|
Shehata S, Abdulmonaem G, Gamal A, Assy M. Spectrum of thoracic systemic venous abnormalities using multidetector computed tomography. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022. [DOI: 10.1186/s43055-022-00756-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Anomalies of the thoracic systemic venous return vary widely and range from those with completely normal physiology to severe right to left shunting thus requiring surgical correction. The aim of the study is to enhance the awareness of multidetector computed tomography (MDCT) role in evaluation of systemic venous abnormalities, and be familiar with the imaging characteristics of even the extremely rare abnormalities.
Results
Among 270 examined patients, 15.19% had systemic venous abnormalities. Inferior vena cava (IVC) congenital anomalies accounted for (24.4%) of the detected abnormalities (prevalence: 3.7% among the studied population) where IVC interruption with azygos continuation was the most common detected IVC abnormality accounting for 17.7% of the detected abnormalities (prevalence: 2.6%), while IVC thrombosis accounted for 21.9% (prevalence: 3.3%). Persistent left sided superior vena cava (SVC) accounted for 14.6% of the detected abnormalities (prevalence: 2.2%), while SVC syndrome represented 19.5% (prevalence: 2.9%) and SVC aneurysm represented 2.4% (prevalence: 0.37%). Retroaortic brachiocephalic vein (BCV) and BCV thrombosis accounted for 7.3% each (prevalence: 1.1). Finally, persistent levo-atrial cardinal vein represented 2.4% of the detected abnormalities (prevalence: 0.37%).
Conclusions
MDCT is a non-invasive modality that can provide detailed information about the systemic thoracic veins before surgical or interventional procedures, especially in patients with congenital anomalies.
Collapse
|
7
|
Clinical implications of congenital interruption of inferior vena cava. J Formos Med Assoc 2022; 121:1938-1944. [DOI: 10.1016/j.jfma.2022.01.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 01/03/2022] [Accepted: 01/17/2022] [Indexed: 11/21/2022] Open
|
8
|
Das S, Roy M, Chattopadhya A, Ganguly D. Intervention Challenges in Patients with Congenital Heart Disease with Coexisting Interruption of the Inferior Vena Cava - A Case Series. Heart Views 2021; 22:224-230. [PMID: 34760057 PMCID: PMC8574097 DOI: 10.4103/heartviews.heartviews_197_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 07/12/2021] [Indexed: 11/04/2022] Open
Abstract
Interruption of the inferior vena cava with azygos continuation is a rare congenital anomaly. This anomaly becomes clinically important during cardiac interventions.
Collapse
Affiliation(s)
- Saurabhi Das
- Department of Paediatric Cardiology, Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, India
| | - Mahua Roy
- Department of Paediatric Cardiology, Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, India
| | - Amitabh Chattopadhya
- Department of Paediatric Cardiology, Narayana Super Speciality Hospital, Howrah, West Bengal, India
| | - Debasree Ganguly
- Department of Paediatric Cardiology, Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, India
| |
Collapse
|
9
|
Toyama H, Takei Y, Saito K, Takahashi K, Suzuki T, Oishi H, Saiki Y, Okada Y, Ejima Y, Yamauchi M. Venovenous Extracorporeal Membrane Oxygenation During Bilateral Lung Transplantation for a Patient With Eisenmenger Syndrome Complicated With Giant Pulmonary Artery Aneurysm, Azygos Continuation, and Central Airway Obstruction. J Cardiothorac Vasc Anesth 2021; 36:3132-3138. [PMID: 34903462 DOI: 10.1053/j.jvca.2021.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/18/2021] [Accepted: 11/05/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Hiroaki Toyama
- Department of Anesthesiology and Perioperative Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
| | - Yusuke Takei
- Department of Anesthesiology and Perioperative Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kazutomo Saito
- Department of Anesthesiology and Perioperative Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kazuhiro Takahashi
- Department of Anesthesiology and Perioperative Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tomoyuki Suzuki
- Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hisashi Oishi
- Department of Thoracic Surgery, Institute of Development, Aging, and Cancer, Tohoku University, Sendai, Japan
| | - Yoshikatsu Saiki
- Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yoshinori Okada
- Department of Thoracic Surgery, Institute of Development, Aging, and Cancer, Tohoku University, Sendai, Japan
| | - Yutaka Ejima
- Division of Surgical Center and Supply, Sterilization, Tohoku University Hospital, Sendai, Japan
| | - Masanori Yamauchi
- Department of Anesthesiology and Perioperative Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| |
Collapse
|
10
|
Savu C, Melinte A, Balescu I, Bacalbasa N. Azygos Vein Aneurysm Mimicking a Mediastinal Mass. In Vivo 2021; 34:2135-2140. [PMID: 32606194 DOI: 10.21873/invivo.12019] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 04/12/2020] [Accepted: 04/30/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND/AIM Azygos vein aneurysm (AVA) is a rare thoracic pathological entity that mimics a posterior mediastinal mass as well as a right paratracheal mass. Usually asymptomatic, AVA is often accidentally discovered during routine chest x-rays; however, depending on the aneurysm size and complications, some symptoms may be present. The aim of this paper is to report a case of idiopathic AVA and to discuss its aetiology, embryonic origin, symptoms, complications, diagnostic methods and treatments. CASE REPORT A 74-year-old female was investigated for diffuse thoracic pain and submitted to standard chest x-ray, which identified a right paratracheal, well-defined, homogenous opacity, considered to be part of the mediastinal shadow. The patient was further submitted to thoracic computed tomography, which confirmed the presence of a tumoral mass at the level of the right paratracheal area. The patient was submitted to surgery and the tumoral mass was resected; however, the tumor proved to be a completely thrombosed aneurism of the azygos vein arch. CONCLUSION AVA is a rare pathology that must be taken into consideration during the differential diagnosis of right postero-superior mediastinal masses.
Collapse
Affiliation(s)
- Cornel Savu
- Department of Thoracic Surgery, "Marius Nasta" National Institute of Pneumophtisiology, Bucharest, Romania.,Department of Obstetrics and Gynecology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Alexandru Melinte
- Department of Thoracic Surgery, "Marius Nasta" National Institute of Pneumophtisiology, Bucharest, Romania
| | - Irina Balescu
- Department of Visceral Surgery, "Ponderas Academic Hospital", Bucharest, Romania
| | - Nicolae Bacalbasa
- Department of Obstetrics and Gynecology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of Visceral Surgery, Center of Excellence in Translational Medicine, "Fundeni" Clinical Institute, Bucharest, Romania.,Department of Obstetrics and Gynecology, "I. Cantacuzino" Clinical Hospital, Bucharest, Romania
| |
Collapse
|