Inferior vena cava hypoplasia with intrahepatic venous continuation: sonographic, angiographic and MR features including MR angiography

Intrahepatic inferior vena cava interruption with transhepatic venous continuation initially misdiagnosed as a congenital portosystemic shunt

We report a case of intrahepatic inferior vena cava interruption with azygos and transhepatic venous continuation discovered incidentally on CT angiography for acute aortic syndrome. The lesion was initially misdiagnosed as a congenital portosystemic shunt on multiphase CT of the liver but subsequent fluoroscopic venogram revealed no evidence of portosystemic shunting. While intrahepatic IVC interruption with azygos continuation is an uncommon but well-known anatomical variant, transhepatic venous continuation is extremely rare and only a few cases have been published. Excluding portosystemic shunting is important for determining management as persistent congenital portosystemic shunts can be associated with significant morbidity.

Azygos Continuation of the Inferior Vena Cava: Potential for Misdiagnosis as Lung Neoplasm

BACKGROUND

The azygos venous system is an accessory venous pathway supplying an important collateral circulation between the superior and inferior vena cava (IVC).

CASE SUMMARY

We report a case of complicated community-acquired pneumonia with interruption of the IVC with azygos continuation that was misdiagnosed as lung neoplasm.

DISCUSSION

The aim of this case report is to emphasize the importance of recognizing an enlarged azygos vein at the confluence with the superior vena cava and in the retrocrural space to avoid misdiagnosis as a right-sided para-tracheal mass. The angiographic features and clinical importance of this condition are discussed.

LEARNING POINTS

An enlarged azygos vein at the confluence with the superior vena cava and in the retrocrural space can be misdiagnosed as a right-sided para-tracheal mass/neoplasm or retrocrural adenopathy.Biopsy is the most important tool to confirm the diagnosis of malignancy but could be catastrophic in this situation.Re-imaging after treatment for infection and pneumonia could potentially avoid this error.

Radiological features of azygos and hemiazygos continuation of inferior vena cava: A case report

RATIONALE

Azygos and hemiazygos continuation of the inferior vena cava (IVC) is uncommon. It is rare especially when it is not associated with congenital heart disease or deep venous thrombosis.

PATIENT CONCERNS

We report an interesting case of an interstitial lung disease with an interrupted IVC with azygous and hemiazygos continuation. A 67-year-old man suffered from cough and shortness of breath.

DIAGNOSES

Computed tomography revealed absence of the hepatic segment of the IVC with azygos and hemiazygos continuation. The patient did not have congenital anomalies of the remaining thoracoabdominal vasculature and viscera. The diagnosis of azygos and hemiazygos continuation of IVC was made by inferior venacavography.

INTERVENTIONS

There was no significant association between interstitial lung disease and expanded azygos and hemiazygos veins. The patient was treated with corticosteroids.

OUTCOMES

After 6 months of follow-up, the patient was asymptomatic.

LESSONS

It is important to recognize the enlarged azygos vein at the confluence with the superior vena cava and in the retrocrural space to avoid misdiagnosis as a right-sided paratracheal mass or retrocrural adenopathy.

Double Inferior Vena Cava (IVC) With Intrahepatic Interruption, Hemiazygos Vein Continuation, and Intrahepatic Venous Shunt

The duplication of the inferior vena cava (IVC) is a rare congenital anomaly, which also has some variations regarding the complex embryological development of the IVC. In the typical form, infrarenal IVC segments are duplicated and the left IVC joins the left renal vein, which crosses anterior to the aorta in the normal fashion to join the right IVC. In variant forms, the interruption of the intrahepatic segment of the IVC, azygos or hemiazygos continuation, or retroaortic course of the renal vein may be seen. An intrahepatic venous shunt accompanying a double IVC variant is an extremely rare anomaly. We report a case of 40-year-old female patient with double IVC, hemiazygos continuation, intrahepatic IVC interruption, and a transhepatic venous shunt.

Acute right lower extremity iliofemoral deep venous thrombosis secondary to an anomalous inferior vena cava: a report of two cases

A congenital anomaly of the inferior vena cava is an increasingly identified risk factor for iliocaval deep venous thrombosis in young patients. We present two cases of acute right lower extremity iliofemoral deep venous thrombosis in 16 and 18-year-old patients that were ultimately diagnosed with an underlying anomalous iliocaval venous system. In one patient, the inferior vena cava was congenitally absent and the right iliac vein was diffusely stenotic with a proximally located high-grade stricture. In the other subject, the infrarenal inferior vena cava and right iliac vein were diffusely hypoplastic. Compensatory venous flow in both subjects was via large perilumbar venous collateral veins and a prominent azygous system. Both patients were successfully treated with a combination of initial catheter-directed thrombolysis followed by balloon angioplasty and venous stent placement.

Incidental right Bochdalek hernia with interruption of the inferior vena cava and hepatic venous collateral continuation: A case report

A 36-year-old asymptomatic female had a routine chest radiograph to exclude pulmonary tuberculosis, as part of an employee wellness programme. There was opacification of the right lower thorax. Computed tomography and venography demonstrated an incidental right Bochdalek hernia with interruption of the inferior vena cava (IVC) and hepatic venous collateral continuation. The association of a Bochdalek hernia with an anomaly of the IVC is rare, with only one case described in the literature.

Thrombosed interrupted inferior vena cava and retroaortic left renal vein mimicking retroperitoneal neoplasm

Anomalies of the inferior vena cava (IVC) have been recognized as one of the predisposing factors for deep vein thrombosis. Rarely, thrombosis of an anomalous retroperitoneal vein may resemble a soft tissue mass. Awareness of this fact helps preventing unnecessary interventions. We report a case of thrombosis of retroaortic left renal vein and interrupted IVC that mimicked a retroperitoneal neoplasm.

Diagnostic techniques in assessing vessels of the gastrointestinal tract

Vascular disorders of the gastrointestinal tract include a variety of different underlying diseases, thus requiring different and, in many cases, more than one imaging procedure. Only a knowledge of the newest developments in vascular imaging techniques with all the possibilities and limits will ensure a time- and cost-effective, accurate and reliable diagnosis. In many acute cases and also as a screening procedure, ultrasound in combination with colour Doppler and duplex sonography, plays an important role in setting the right course for further imaging techniques, and can provide the correct diagnosis in many cases.Depending on the most prominent symptoms and the expected disease, the right choice of technique saves valuable time. Computed tomography (CT) and magnetic resonance imaging (MRI) are cross-sectional imaging techniques that not only demonstrate lesion vascularization, but also provide information about neighbouring structures and complications in an understandable and demonstrable way. The use of angiography as an invasive tool should be limited to cases where a high temporal and spatial resolution is necessary to make the diagnosis or where therapeutic interventions are also likely to be performed within the same setting. For the diagnosis of gastrointestinal vascular diseases, often no generally valid recommendation can be given, since the impact of all imaging techniques will depend on the examiner's experience, the technical equipment and on their 24-h availability in a hospital. This chapter tries to give some information about the inherent limits and indications of the different imaging techniques, as well as the newest study results concerning the most frequent vascular diseases of the gastrointestinal tract.