|Year : 2016 | Volume
| Issue : 1 | Page : 42-44
Unusual variant of infrarenal duplication of inferior vena cava
Ranjan Kumar Sahoo1, P Bahinipati1, Sitansu K Panda2
1 Department of Radio-diagnosis, IMS and SUM Hospital, Bhubaneswar, Odisha, India
2 Department of Anatomy, IMS and SUM Hospital, Bhubaneswar, Odisha, India
|Date of Web Publication||13-Jan-2016|
Ranjan Kumar Sahoo
Department of Radio-diagnosis, IMS and SUM Hospital, Bhubaneswar - 751 003, Odisha
Source of Support: None, Conflict of Interest: None
Infrarenal inferior vena cava (IVC) duplication is a rare anomaly. Most of the cases are asymptomatic and are detected incidentally. Prior knowledge of the anomaly is essential for safe procedure by intervention radiologist, retroperitoneal operation, and multi-visceral recovery operation from deceased donor by surgeon. We report a case of infrarenal IVC duplication detected incidentally during contrast-enhanced computed tomography examination of abdomen of a patient presenting with viral hepatitis and mild obstructive jaundice.
Keywords: Anomaly, duplication, inferior vena cava, renal
|How to cite this article:|
Sahoo RK, Bahinipati P, Panda SK. Unusual variant of infrarenal duplication of inferior vena cava. Int J Health Allied Sci 2016;5:42-4
|How to cite this URL:|
Sahoo RK, Bahinipati P, Panda SK. Unusual variant of infrarenal duplication of inferior vena cava. Int J Health Allied Sci [serial online] 2016 [cited 2022 Oct 5];5:42-4. Available from: https://www.ijhas.in/text.asp?2016/5/1/42/173873
| Introduction|| |
Right-sided inferior vena cava (IVC) in normal adults is formed by complex anastomosis between three pairs of embryonic veins during 8th week of intrauterine life and seen on the right side of abdominal aorta in majority of population. Duplication of IVC is a congenital anomaly in which right and left IVC (RIVC and LIVC) join at renal vein level to form a single right side suprarenal IVC and is reported to occur in 0.2–3% of the population. PubMed database search on October 22, 2015 for the duplication of IVC revealed, about 20 cases were published during the last 5 years. Our case is unique as we report an interesting variant of IVC duplications detected in computed tomography examination of abdomen where the LIVC is formed by continuation of left external iliac vein (LEIV) and RIVC is formed by both right external, internal iliac vein and left internal iliac vein (LIIV).
| Case Report|| |
A 47-year-old female patient reported to radiology department for contrast-enhanced computed tomography (CECT) of abdomen for the evaluation of jaundice and pain abdomen. She had raised serum direct bilirubin level and was diagnosed to have obstructive jaundice. Her CECT of abdomen revealed normal gall bladder and biliary tree. Incidentally, her IVC showed infrarenal duplication. Two IVCs (RIVC and LIVC) were seen; one on either side of the descending abdominal aorta. On reaching the level of the left renal vein at L2 vertebral level, both the vena cavae joined to form a single right-sided suprarenal IVC. The RIVC is formed by right common iliac vein (RCIV) and LIIV just below the level of aortic bifurcation. The LIIV alone continues upward to join the RIVC without the formation of left common iliac vein (LCIV). The LIVC was formed by LEIV alone. The RCIV confluence was normal in position and was formed by the union of right external iliac vein and right internal iliac vein at the upper part of right sacroiliac joint level. The single right-sided suprarenal IVC was draining to right atrium [Figure 1]. After serological test, the patient was diagnosed to have hepatitis A virus infection with mild obstructive jaundice. CECT scan image of abdomen of another patient showed normal anatomy of IVC and its tributaries in [Figure 2].
|Figure 1: Contrast-enhanced computed tomography of abdomen shows right inferior vena cava and left inferior vena cava on lateral aspects of abdominal aorta in coronal and axial image (a and b), right inferior vena cava formation (c) by the union of right common iliac vein and small caliber left internal iliac vein, left inferior vena cava formation by left external iliac vein alone and continuation of left internal iliac vein to right inferior vena cava. (c-e) Both inferior vena cavae join at renal vein level. RIVC: Right inferior vena cava; LIVC: Left inferior vena cava; AO: Aorta; LIIV: Left internal iliac vein; LEIV: Left external iliac vein|
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|Figure 2: Contrast-enhanced computed tomography of abdomen of another patient shows single right-sided inferior vena cava on the right side of aorta in coronal and axial image (a and b), formation of inferior vena cava by the union of right common iliac vein and left common iliac vein in axial image (c). RCIV: Right common iliac vein; LCIV: Left common iliac vein; RIVC: Right inferior vena cava; AO: Aorta|
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| Discussion|| |
Congenital IVC anomalies such as LIVC, duplication of IVC, circum-aortic renal vein, retrocaval renal vein, and azygos/hemiazygos continuation of IVC are incidentally detected during imaging as most of the patients are asymptomatic and occurs in 2–3% of population. However, duplication of IVC is a rare congenital anomaly and was first described in 1916 at the gross anatomy laboratory in London. Several reports of IVC duplication have been published since then with quoted incidence of 0.3–3% of population. The development of IVC occurs between 4 and 8 weeks of intrauterine life and involves development, regression, anastomosis, and replacement between three pairs of embryonic veins such as the posterior cardinal veins, the subcardinal veins, and the supracardinal veins, which arise in a chronological order., One pair of posterior cardinal vein appears on the posterior aspect of embryo during 6th week of gestational life and forms the dominant system for drainage of body wall caudal to heart. It regresses except the distal segment which forms the iliac bifurcation. During 7th week of gestational life, one pair of subcardinal vein develops anterior and medial to posterior cardinal vein. The left subcardinal vein regresses completely whereas the right subcardinal vein persists to form the suprarenal segment of IVC. Subsequently, a pair of supracardinal vein develops dorsolateral to subcardinal veins and medial to regressed posterior cardinal vein during 4th–8th week of intrauterine life. They extend above diaphragm to form azygos and hemiazygos veins. The left supracardinal vein regresses. The right supracardinal vein forms the infrarenal segment of IVC.
Anastomotic channels between the supracardinal and subcardinal veins form the intervening renal segment of the IVC. The hepatic part of IVC is formed by right vitelline vein., Duplication of IVC occurs due to persistence of both right and left supracardinal veins. Tsuyoshi et al. describes duplication of IVC with continuation of LEIV as LIVC and formation of RIVC by both side common iliac veins. The LCIV was formed by LIIV and branch from LEIV. Our case is similar to the above case except the finding that the LCIV is formed by LIIV alone without any contribution from the LEIV.
Congenital duplication of IVC is detected in routine cross-sectional imaging and cadaveric dissection. Patients with this anomaly are usually asymptomatic. It may increase the risk for development of deep vein thrombosis, especially in young adults due to slow flow, inadequate venous return, and increased venous pressure in the veins of both the lower legs. Some of the IVC anomalies are associated with congenital heart disease. The recurrent pulmonary embolism in spite of placement of IVC filter should raise the suspicion of duplication of IVC.
Cross-sectional imaging such as CT scan, magnetic resonance imaging, and contrast/carbon dioxide cavogram before IVC intervention well demonstrate the presence of this anomaly. Prior knowledge of IVC duplication prevents disastrous consequence during retroperitoneal surgery, interventional venous radiological or cardiovascular procedure, and liver transplantation., The LIVC may be misdiagnosed as retroperitoneal lymph node in case of poor contrast opacification of IVC in CT scan of abdomen. In our case, the patient had viral hepatitis A with jaundice and was incidentally found to have infrarenal IVC duplication in CECT of abdomen. No correlation was found between viral hepatitis and the IVC anomaly. Such association is not reported before. One case report of retrocaval ureter with the duplication of IVC has been reported in 2014.
In conclusion, knowledge of normal and abnormal anatomy of IVC is essential for correct vascular anatomy interpretation in imaging for liver surgery, radiological/cardiovascular venous intervention, and retroperitoneal surgery. This anomaly is well demonstrated in detail by multi detector CECT study of abdomen with three-dimensional maximum intensity projection and reconstructions.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Moore KL, Persaud TV. The cardiovascular system. In: Moore KL, editor. The Developing Human: Clinically Oriented Embryology. 8th
ed. London: Saunders; 2008. p. 285-336.
Natsis K, Apostolidis S, Noussios G, Papathanasiou E, Kyriazidou A, Vyzas V. Duplication of the inferior vena cava: Anatomy, embryology and classification proposal. Anat Sci Int 2010;85:56-60.
Lucas MF. A case of double inferior vena cava. J Anat 1916;51:69-70.
Chen H, Emura S, Nagasaki S, Kubo KY. Double inferior vena cava with interiliac vein: A case report and literature review. Okajimas Folia Anat Jpn 2012;88:147-51.
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;20:639-52.
Mathews R, Smith PA, Fishman EK, Marshall FF. Anomalies of the inferior vena cava and renal veins: Embryologic and surgical considerations. Urology 1999;53:873-80.
Tsuyoshi S, Sadaharu K, Koichi W, Akira Y, Hiroko S, Takeshi H, et al
. A case of the double inferior vena cava with hepatofugal collateral. J Kurume Med Assoc 2005;68:339-45.
Gayer G, Luboshitz J, Hertz M, Zissin R, Thaler M, Lubetsky A, et al.
Congenital anomalies of the inferior vena cava revealed on CT in patients with deep vein thrombosis. AJR Am J Roentgenol 2003;180:729-32.
Actis-Dato A, Tarquini A, Cortis B. Anomalies of the inferior vena cava. Description of 4 cases. Minerva Cardioangiol 1965;13:497-504.
Kouroukis C, Leclerc JR. Pulmonary embolism with duplicated inferior vena cava. Chest 1996;109:1111-3.
Trigaux JP, Vandroogenbroek S, De Wispelaere JF, Lacrosse M, Jamart J. Congenital anomalies of the inferior vena cava and left renal vein: Evaluation with spiral CT. J Vasc Interv Radiol 1998;9:339-45.
Coelho JC, Ramos EJ, da Costa MA, Pissaia A, Junior CA. Liver transplantation in a patient with complex anomaly of the inferior vena cava. Hepatobiliary Surg Nutr 2014;3:212-5.
Dudekula A, Prabhu SD. A rare case of right retrocaval ureter with duplication of infrarenal IVC. Case Rep Radiol 2014;2014:345712.
[Figure 1], [Figure 2]