Renal angiomyolipoma with coexistent hemorrhagic aneurysm formation and fatty thrombus in inferior vena cava: a rare presentation

Angiomyolipoma (AML) is known as the most common benign mesenchymal tumor of kidney. Usually AMLs present as benign lesions without local invasion or complication. However, few cases of renal AML have been reported with complications such as tumor thrombus extension into inferior vena cava (IVC) or hemorrhagic aneurysm formation. We report a complicated case of renal AML with CT and angiography evidence of hemorrhagic aneurysm formation and IVC thrombus, treated by a combination of selective arterial embolization, radical nephrectomy and thrombectomy. Radiologists and clinicians should be aware that AMLs could have such aggressive behaviors.     

Radiofrequency catheter ablation of a coronary sinus-ventricular accessory connection in dextrocardia with complete situs inversus and an anomalous inferior vena cava

An anomalous inferior vena cava (IVC) is often associated with patients with dextrocardia. However, radiofrequency catheter ablation in such a case with that combination has not been reported. We encountered a case of Wolff-Parkinson-White syndrome with dextrocardia associated with complete situs inversus and an azygos continuation of the IVC. A steep angulation at the junction of the azygos vein and superior vena cava precluded the precise mapping of the anatomical right cavity with a femoral vein approach. Successful catheter ablation of an accessory connection between the coronary sinus and left ventricle could be achieved with a right cubital vein approach.     

Persistent right umbilical vein in a fetus with Noonan's syndrome: a case report.

We present a case of persistent right umbilical vein with Noonan's syndrome. Persistence of the right umbilical vein with no intrahepatic portion is an uncommon finding with a review of the literature revealing only five other cases. In these cases drainage was directly into the right atrium, inferior vena cava (IVC) or IVC via the iliac vein. Of the reported cases Noonan's syndrome was confirmed in one case and suspected in a second. This report represents a third case of persistent right umbilical vein with confirmed Noonan's syndrome.     

产前超声应用微血流灌注成像技术诊断胎儿下腔静脉畸形的价值

目的探讨产前超声应用微血流灌注(MV-Flow)成像技术诊断胎儿下腔静脉畸形的价值。 方法选择2020年6月至2021年6月成都市妇女儿童中心医院超声科22 787例孕妇行20~24周胎儿系统超声检查中，产前诊断为下腔静脉畸形的胎儿，应用MV-Flow技术和多切面分段观察法观察下腔静脉，发现下腔静脉畸形时启用时间-空间关联成像(STIC)技术明确诊断。产后引产儿尸体解剖或儿童超声检查追踪观察，对比3种检查方法的产前诊断准确性，并比较操作耗时。 结果产前诊断67例下腔静脉畸形，均经产后证实。应用MV-Flow技术观察下腔静脉，声像表现为：下腔静脉中断时肝静脉未汇入下腔静脉而直接汇入右心房，左下腔静脉呈"S"形走行，双下腔静脉呈"h"形走行。MV-Flow技术、多切面分段观察和STIC技术3者的诊断准确性一致。MV-Flow技术平均用时(10.16±2.48)s/例，多切面分段观察平均用时(34.75±11.04)s/例，STIC技术平均用时(225.11±36.67)s/例，三者比较差异有统计学意义(Z＝126，P<0.01)。 结论产前超声应用MV-Flow技术观察下腔静脉，产前诊断准确率高，操作简便，适合推广应用。     

Aneurysm of the inferior vena cava: case report

Venous aneurysms are uncommon. Despite their infrequency, venous aneurysms can present with significant clinical complications such as thrombosis, pulmonary embolism, and death. In this report, we present the case of a thrombosed inferior vena cava aneurysm discovered in a 16-year-old male who had deep vein thrombosis of the right lower extremity. Thrombosis of the inferior vena cava is uncommon in the pediatric population. Therefore, congenital abnormalities such as an inferior vena cava aneurysm should be considered when evaluating pediatric patients who present with deep vein thrombosis.     

肾癌并肝下型下腔静脉癌栓的手术治疗并文献复习

目的探讨肾细胞癌并下腔静脉癌栓的手术治疗方法。方法回顾性分析6例经手术及病理证实的肾细胞癌并肝下型下腔静脉癌栓患者的临床资料,所有病例均行根治性肾切除并癌栓切除术,分别采用下腔静脉切开、下腔静脉部分切除和节段性下腔静脉切除三种方法取出癌栓。结果 6例手术均获成功,无大出血、肺梗塞等并发症,术后患者恢复良好。其中2例分别于术后38个月和76个月死亡,3例仍健在,平均存活时间为54个月,1例术后18个月后失访。结论右肾癌并下腔静脉癌栓患者下腔静脉节段性切除能够安全地进行,根治性肾切除并癌栓切除术能够使患者获得长期存活。     

Sonographic appearance of lipoma of the inferior vena cava.

Lipomas of the major central veins are rare, and their sonographic features have rarely been reported. We report a case in which a lipoma of the inferior vena cava (IVC) was incidentally identified during liver sonography in a 68-year-old man. Sonography of the upper abdomen revealed coarsening of the liver echotexture, with a relatively small liver and atrophy of the right hepatic lobe. A 2-cm hypoechoic hepatic nodule was visualized in segment IV. Sonography also showed a 2.2- x 1.8-cm, highly echogenic, homogeneous nodule in the hepatic segment of the IVC at its junction with the right atrium. The lumen of the IVC was partially occluded. The CT and MRI appearances of the IVC lesion were consistent with a lipoma, which was not treated because there was no clinical evidence of obstruction. Histopathologic analysis following a sonographically guided biopsy of the liver nodule revealed hepatocellular carcinoma, which was treated by percutaneous ethanol injection.     

Type I and II circumcaval ureter in children: Experience in three cases

Circumcaval ureter is a congenital abnormality in which the right ureter passes behind the inferior vena cava (IVC), but it is seldom reported in childhood. Surgery is required for symptomatic cases to transect and reposition the right ureter to lie anterior to the IVC in order to correct this abnormality. We present three childhood cases where two types of obstructive circumcaval ureter were diagnosed and treated surgically.     

双下腔静脉并右肾重复肾胎儿产前超声诊断学特征并文献复习

目的探讨双下腔静脉并右肾重复肾胎儿产前超声诊断学特征。 方法回顾性分析2019年8月5日湖北省妇幼保健院超声科诊断的1例双下腔静脉并右肾重复肾胎儿的产前超声资料，总结双下腔静脉的超声声像图特征，并复习文献。 结果胎儿超声检查右肾见2个肾盂和2组肾静脉，腹部冠状切面显示下腔静脉在肾脏水平向左跨过腹主动脉，肾水平以下与腹主动脉并行左、右侧各见一支下腔静脉，呈"平行三血管征"，双下腔静脉血流走行一致。彩色多普勒超声显示双下腔静脉与腹主动脉血流方向相反，并记录到静脉频谱。 结论掌握双下腔静脉胚胎学基础及超声声像图特征，有利于提高产前超声检出率。     

Tumor extending through inferior vena cava into the right atrium. A late recurrence of renal cell carcinoma

Renal cell carcinoma is a tumor with a distinct feature; it can invade through renal vein to the inferior vena cava (IVC) and growths intravascularly extending sometimes into the right cardiac chambers. Previous reports of renal cancer with extension to the right atrium at the time of diagnosis have been published. We present the case of a patient with a right atrial mass arising from the IVC found by echocardiography, which was subsequently proved to be a recurrence of renal cell carcinoma 5 years after radical nephrectomy.     

Hepatocellular carcinoma with tumor thrombus in the inferior vena cava and right atrium

Tumor thrombus (TT) in the inferior vena cava (IVC) and right atrium (RA) is rarely encountered. We have diagnosed before death and treated a case of hepatocellular carcinoma (HCC) with TT in the IVC and RA, accompanied by a brain metastasis. The image characteristics on computed tomography (CT), magnetic resonance imaging (MRI), and conventional angiography are discussed.     

A case of successfully treated inferior vena cava injury

The inferior vena cava (IVC) is the most frequently injured retroperitoneal vascular structure. Despite the improvements in preoperative care and operation techniques, mortality rates for inferior vena cava injuries are still high due to delayed or inadequate volume recussitation, difficulty of diagnosis and technical problems in repair. A 1.5-cm sized wound at the IVC was primarly repaired by suturing. Because of appropriate and successful perioperative blood and fluid resuscitation, the patient was able to survive. We report a case of successfully treated IVC injury caused by a gunshot.     

Slow pathway ablation for atrioventricular nodal reentry using a right internal jugular vein approach: a case series

BACKGROUND: Inferior venous access to the right heart is not possible in some patients due to congenital or acquired obstruction of the inferior vena cava (IVC). Although right-sided electrophysiology procedures have been performed successfully in patients with a previously placed IVC filter by direct placement of catheters through the filter, an alternative approach is necessary in some patients. METHODS: This case series describes three patients with an IVC filter who underwent successful ablation of the slow pathway for typical atrioventricular (AV) nodal reentrant tachycardia using a superior vena cava (SVC) approach via the right internal jugular (IJ) vein. Two separate introducer sheaths were placed into the IJ vein using separate punctures. This permitted placement of a standard deflectable ablation catheter and an additional catheter in the right atrium to monitor for ventriculoatrial conduction during the junctional rhythm associated with ablation of the slow AV nodal pathway. RESULTS: Catheter ablation was successful in each patient. The number of radiofrequency current applications was 7, 17, and 27. There were no procedural complications and no patient had recurrent tachycardia during follow-up. CONCLUSIONS: Catheter ablation of the slow AV nodal pathway can be performed successfully and safely in patients with inferior venous barriers to the right heart using an SVC approach via the right IJ vein.     

Infantile myofibroma: a case report and review of the literature.

This article presents a case report of a 37-week gestational age (GA) female infant (CK) whose first ultrasound at 35 weeks' GA revealed polyhydramnios, fetal ascites, and a possible diaphragmatic hernia. At birth, CK had a grossly distended abdomen, prominent abdominal veins, hepatomegaly, bounding femoral pulses, and generalized edema. Initial imaging identified an absent ductus venosus, absent segment of the inferior vena cava (IVC), and prominent superior vena cava to the right atrium. A computed tomography (CT) scan showed a mass contiguous with the liver causing compression of the IVC. Biopsy confirmed infantile myofibromatosis (IM), an uncommon soft tissue neoplasm that may present at birth or in early infancy. Although rare, this neoplasm is the most common fibrous tumor of infancy. The case of CK was unusual because the solitary IM lesion was in an atypical location; a solitary lesion is not commonly found in the viscera, and solitary lesions are predominant in males. Although lesions are often benign, visceral involvement is associated with high mortality. The cause is unknown, although familial cases have been reported. This article describes the key features of IM, possible treatment options, nursing care, and prognosis for infants with the disease.     

胸内负压对正常人下腔静脉血流的影响

目的：观察胸内压力变化对正常人下腔静脉血流的影响。方法：用口件控制正常人气道出入口面积造成不同的气道呼吸阻力,改变胸内负压随呼吸的变化幅度。运用多普勒超声观察不同的气道阻力情况下,下腔静脉血流随呼吸的变化。结果：胸内负压的变化对下腔静脉血流的影响非常显著;呼气相的持续时间影响其后吸气相的下腔静脉血流速度;吸气相的发生的时间对吸气时第一心动周期的右心充盈增量有一定影响     

Safety of Implantation of a Leadless Pacemaker via Femoral Approach in the Presence of an Inferior Vena Cava Filter

A 61‐year‐old woman with symptomatic complete heart block was referred for permanent pacemaker. The presence of a left‐sided arteriovenous fistula and right‐sided mastectomy with lymph node dissection precluded the implantation of a transvenous pacemaker, and therefore, a leadless pacemaker was recommended. The patient also had an inferior vena cava (IVC) filter. The passage of a 27‐French introducer sheath housing the leadless pacemaker through IVC filter was carefully visualized under fluoroscopy and advanced to the right ventricle without any compromise to the filter. This case report shows the safety of passage of large sheaths via the IVC filter.     

Radiofrequency catheter ablation of common atrial flutter in a patient with anomalous inferior vena cava and azygos continuation

We describe a case of isthmus-dependant atrial flutter ablation with a superior approach due to an anomalous inferior vena cava (IVC), azygos, and emiazygos continuation. A 56-year-old man was referred to our institution for the treatment of a common atrial flutter. Two years prior, the patient had an attempted electrophysiological study not performed due to the inability to advance the guidewire through IVC. A computed tomography of the abdominal venous system revealed the absence of the subrenal IVC, azygos, and emiazygos continuation. Following double puncture of the left subclavian vein, two catheters were inserted into the coronary sinus and into the right atrium. Programmed atrial stimulation was performed and a sustained isthmus-dependant right atrial tachycardia was obtained. After 11 applications of radiofrequency energy with an inversion technique, sinus rhythm was restored and a repeat atrial programmed stimulation failed to induce any arrhythmia.     

Interrupted inferior vena cava and left-sided subrenal inferior vena cava: prenatal diagnosis.

An interrupted inferior vena cava (IVC) and a left-sided subrenal (postrenal) IVC with azygos or hemiazygos continuation are very rare anomalies of the IVC. The prenatal sonographic and color Doppler features of these anomalies are reported here.     

月经紊乱, 下肢浮肿, 急性肾损伤——罕见盆腔占位的"瘤栓事件"

低级别子宫内膜间质肉瘤(low-grade endometrial stromal sarcoma, LG-ESS)是一种罕见的子宫恶性肿瘤, 在所有子宫恶性肿瘤中占比不足1%, 目前国内外尚无关于LG-ESS导致急性完全性下腔静脉阻塞的报道。2020年11月, 北京协和医院血管外科接诊1例LG-ESS患者, 临床表现为月经紊乱、右下肢凹陷性水肿、突发恶心、少尿、肌酐升高, 影像学提示下腔静脉完全性阻塞, 通过多学科协作共同决策, 采用分期手术联合内分泌治疗成功救治该患者, 其诊疗过程体现了多学科协作在疑难重症患者诊治中的重要作用。     

Hepatocellular carcinoma with invasion into right cardiac cavities: report of a case and literature review.

Hepatocellular carcinoma is a tumor that rarely invades the inferior vena cava and right heart. We describe the case of a 63-year-old man with jaundice and a history of cryptogenic hepatic cirrhosis with diagnosis of hepatocellular carcinoma. He was referred to the echocardiography laboratory for sudden dyspnea and suggestion of pulmonary thromboembolism. Echocardiographic study reported a mass in the right atrium proceeding from the inferior vena cava.