Hippokratia 2015, 19(1):95
Papoutsis D1, Tsatsali Foroglou E2
1Department of Maternity, Royal Shrewsbury Hospital, Shrewsbury, United Kingdom, 2Radiology Department, EUROMEDICA Radiology Center, Thessaloniki, Greece
Key words: Inferior vena cava, azygos vein, imaging
The inferior vena cava (IVC) is a single vein located to the right of the abdominal aorta. When failure in the process of embryogenesis occurs, this may lead to congenital anomalies of the IVC.
A 29-year-old male patient presented with a two-week history of chest pain and coughing. Initial imaging showed a right cardiophrenic angle opacification on chest radiograph and dilatation of the azygos vein on contrast-enhanced lung computerized tomography imaging. Subsequent magnetic resonance imaging of the thorax and abdomen revealed a left IVC (diameter: 16 mm) crossing posteriorly to the abdominal aorta and draining into the azygos vein (diameter: 13 mm) (Figure 1). The suprarenal segment of a right IVC (diameter: 9 mm) was also noted ascending parallel to the abdominal aorta and draining into the superior vena cava, which in turn drained into the right atrium of the heart. The hemiazygos vein was present with no obvious abnormality.
On review of the literature the most common IVC anomalies involve a double IVC (1-3%), left-sided IVC (0.2-0.5%), and azygous continuation of a right-sided IVC (0.6%)1. This is the first case to report on such a complex IVC variant.
IVC abnormalities have been associated with congenital heart anomalies, asplenia/polysplenia syndromes and situs anomalies1. There is a slight preponderance in males and an association but no genuine link with renal and testicular malignancy2. IVC abnormalities can cause clinical problems during retroperitoneal surgery, diagnostic imaging and interventional radiology1-3. Increased awareness is therefore necessary for physicians that may be involved with these anomalies in clinical practice.
Figure 1. On the left, coronal image of magnetic resonance angiography with contrast enhancement. The left inferior vena cava (IVC), azygous continuation of the left IVC, and the suprarenal segment of the right IVC are visualised. On the right, schematic representation.
1. Bass JE, Redwine MD, Kramer LA, Huynh PT, Harris JH Jr. Spectrum of congenital anomalies of the inferior vena cava: cross-sectional imaging findings. Radiographics. 2000; 20: 639-652.
2. Ang WC, Doyle T, Stringer MD. Left-sided and duplicate inferior vena cava: a case series and review. Clin Anat. 2013; 26: 990-1001.
3. Hayashi S, Naito M, Hirai S, Terayama H, Miyaki T, Itoh M, et al. Proposal for a new classification of variations in the iliac venous system based on internal iliac veins: a case series and a review of double and left inferior vena cava. Anat Sci Int. 2013; 88: 183-188.