The value of ultrasonography in interrupted inferior vena cava with azygos continuation.

The cardiosplenic syndromes represent a complex set of abnormalities of the thorax and viscera resulting from abnormal folding of the embryo during early development. Anomalies of venous development include interruption of inferior vena cava (IVC), and in combination with situs inversus referred to as the polysplenia syndrome. We present a 23-year-old male previously diagnosed as having a persistent left IVC on venography whereas ultrasonographic examination clearly demonstrated interrupted IVC with azygos continuation along with situs inversus.     

Prenatal diagnosis of interrupted inferior vena cava as an isolated finding: a benign vascular malformation.

We report two cases of interrupted inferior vena cava with azygous continuation diagnosed as an isolated finding during routine prenatal scans. Visualization of the venous vasculature of the abdomen and thorax in the mid-sagittal plane failed to visualize the segment of the inferior vena cava between the kidneys and the liver. A vessel with venous flow was observed parallel, adjacent and posterior to the aorta between the kidney and the right atrium. This blood vessel connected with the superior vena cava. Axial planes of the thorax confirmed the presence of two vessels running paravertebrally. A detailed ultrasound examination of the fetal anatomy failed to demonstrate other anomalies. The neonatal course of both fetuses was uneventful. Isolated interruption of the inferior uena cava can be a vascular malformation without known pathological consequences.     

Azygos continuation of the inferior vena cava masquerading as neoplasm

The two cases we have reported demonstrate that dramatic enlargement of the azygos vein may occur in patients with azygos continuation of the inferior vena cava. Awareness of this phenomenon can prevent unnecessary procedures. The diagnosis should be established by dynamic CT scan.     

Successful cryoablation of atrial fibrillation from jugular approach in patient with interrupted inferior vena cava and azygos continuation

We herein report successful cryoablation of paroxysmal atrial fibrillation via right jugular vein in a patient with interrupted inferior vena cava. We preferred cryoablation instead of radiofrequency ablation in the treatment of our patient. For stronger support in aiming the Brockenbrough needle toward the septum, we manuallly curved the needle with a 120° angle about 6 cm proximal to the tip. After successful transseptal puncture, we performed balloon dilatation in the septal puncture zone to facilitate passage. Cryoablation has theoretical advantage, particularly in challenging anatomies, in which it eliminates the need for point‐by‐point ablation around the pulmonary vein.     

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.     

下腔静脉离断产前超声诊断

目的 探讨胎儿下腔静脉离断产前超声声像图特征和有效诊断切面,以提高其产前超声诊断准确率.方法 回顾性分析我院2006年1月至2010年5月诊断的10例下腔静脉离断胎儿(其中7例经引产后尸体解剖证实)产前超声声像图,与正常超声声像图对比,总结其产前超声声像图特征及有效切面.结果 10例下腔静脉离断胎儿,9例合并严重心内结构畸形,7例合并心外结构畸形(其中5例合并内脏反位).本组10例下腔静脉离断胎儿产前超声声像图均表现为四腔心切面异常(奇静脉扩张)、上腹部横切面异常(正常下腔静脉不能显示)、胸腹部斜冠状切面异常[离断的下腔静脉异位连接于奇(半奇)静脉并穿过膈肌连于腔静脉]及右心房纵切面异常(肝上段下腔静脉入右心房,肾上段肝段间的下腔静脉缺失并离断).结论 下腔静脉离断常合并心内、外结构畸形.下腔静脉离断胎儿在四腔心切面、上腹部横切面、胸腹部斜冠状切面及右心房纵切面上均有特征性超声声像图表现.识别下腔静脉离断特征性超声声像图表现可明显提高其产前超声检出率和诊断准确率.     

A case of prenatally detected left isomerism and hemiazygos continuation of inferior vena cava

Heterotaxy syndromes are defined as the disorders that involve abnormal arrangement of viscera. We present a case of prenatally diagnosed left isomerism in a 30‐year‐old primigravida woman referred to our hospital for complex cardiac abnormality. Sonographic findings included heart block, unbalanced atrioventricular septal defect, interruption of the inferior vena cava with hemiazygos continuation, double superior vena cava, a right‐sided stomach, and biliary atresia. The hemiazygos vein drained into the right atrium by the persistent left superior vena cava. This type of inferior vena cava interruption and continuation is rarely reported in prenatally detected cases of left isomerism. © 2017 Wiley Periodicals, Inc. J Clin Ultrasound 45 :430–433, 2017     

左下腔静脉伴半奇静脉延续1例

患者女,50岁,外伤后胸片示主动脉增宽,疑主动脉夹层动脉瘤.CT:肾上段至肝段下腔静脉缺如(图1),左肾静脉以下下腔静脉位于腹主动脉左侧(图1A),右肾静脉经腹主动脉后方汇入左下腔静脉(图1B),左下腔静脉在L1平面汇入扩大的半奇静脉,并在主动脉后方上行,于T8平面延续为副半奇静脉,至T4平面连接扩大的左上肋间静脉,绕主动脉弓左侧向前汇入左头臂静脉后下缘(图1C);奇静脉缺如,肝静脉经肝段下腔静脉直接汇入右心房.临床诊断为左下腔静脉伴半奇静脉延续.     

产前超声诊断左位下腔静脉并下腔静脉离断异位连接奇静脉1例

患者女,22岁,已婚,孕3产1,妊娠期无糖尿病、高血压病,地中海贫血基因检测未见异常;唐氏筛查提示18-三体高风险,无创基因检查低风险,未行羊膜穿刺。孕24周行系统超声检查:胎儿上腹部横切面示腹腔脏器正位,腹主动脉位于脊柱左前方,未见肝段下腔静脉,腹主动脉的右后方可见扩张奇静脉,内径约3.5 mm(图1);胸腹冠状面检查:向上追踪于降主动脉右侧平行上行通过奇静脉弓汇入右侧上腔静脉,彩色多普勒示主动脉和扩张的奇静脉血流方向相反;向下追踪可见其与左位下腔静脉相连,继续追踪,可见左右肾静脉汇入其内(图2),于近膈肌水平可见该静脉跨越腹主动脉后方与腹主动脉右后方奇静脉相连(图3,4)。胎儿心脏:四腔心结构及大动脉连接未见明显异常,于左心房后方降主动脉右侧可见扩张的奇静脉,胸腹斜冠面可见三支肝静脉及静脉导管直接人右心房。     

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.     

Leiomyosarcoma of the inferior vena cava. Ultrasonographic appearance

Ultrasonographic features of six leiomyosarcomas of the inferior vena cava are described. In most cases, the presentation is typical enough to strongly suggest the histologic diagnosis. The tumor is usually greater than 10 cm long, hypoechoic, heterogeneous. Cystic components can be found. It is sharply demarcated from neighboring organs which are displaced. The mass is located at the very place of the inferior vena cava, the lumen of which is no longer seen. It is fusiform shaped, surprisingly sparing the aorta. Differential diagnosis along with other radiologic examinations, pathologic findings, and prognosis are discussed.     

Spectrum of the inferior vena cava: MDCT findings

Inferior vena cava (IVC) abnormalities are not uncommon. Congential anomalies, thrombosis, neoplasms, and obstructive lesions can involve IVC. With the wide use of multidetector CT, it has demonstrated its ability to display the abnormalities of IVC. Congenital anomalies, thrombosis, neoplasms, and stenosis or obstructive diseases and other abnormalities can be demonstrated by MDCT. We present a pictorial essay to illustrate its roles in detecting and defining the nature of lesions of IVC, from the anatomy to disease spectrum of IVC.     

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.     

Bullet migration within the inferior vena cava

We report the case of a patient who sustained gunshot wounds to the chest. The bullet lodged and moved freely within the inferior vena cava and its branches, but the patient had no symptoms. The bullet was retrieved from the right common femoral vein with a basket. Selective approach to bullet removal can prevent serious complications.     

下腔静脉发育异常的产前超声图像特征及临床意义

目的  总结胎儿下腔静脉（IVC）发育异常超声图像特征,探讨产前超声检查价值及临床意义。方法  回顾性分析我院2018年1月~2023年2月产前诊断为胎儿IVC发育异常的88例孕妇的超声图像特征及合并心内外异常情况;不同类型IVC发育异常合并心内外异常构成比行多列表卡方检验,采用Bonferroni方法行组间多重比较。所有结果与产后MRA及超声心动图或尸检结果进行对比。结果  88例IVC发育异常胎儿中,下腔静脉异常连接（ECIVC）18例,肾后段左下腔静脉（LIVC）42例,双下腔静脉（DIVC）28例。18例ECIVC胎儿胸腹斜冠状切面及四腔心切面均表现异常,其中腹部横切面异常17例,腹部横切面异常征象不典型1例;2例右心房纵切面表现异常;42例LIVC胎儿超声IVC冠状切面均呈“S”征;28例DIVC胎儿超声IVC冠状切面均呈“h”征。88例IVC发育异常胎儿分别合并心血管系统、骨骼系统、泌尿系统、消化系统、呼吸系统及感觉系统异常;不同类型IVC发育异常孤立性及合并心内外异常构成比总体差异有统计学意义（P < 0.001）;孤立性ECIVC与孤立性DIVC及孤立性LIVC构成比、ECIVC合并心内异常与LIVC及DIVC合并心内异常构成比的差异有统计学意义（P < 0.05）。88例IVC发育异常胎儿,5例经引产证实;83例随访至出生后6月,均行MRI及超声心动图检查,与产前诊断一致。结论  胎儿IVC发育异常在超声图像上具有特异性,超声能准确识别其有无合并心内外结构异常,分析不同类型IVC发育异常合并心内外结构异常构成比可以为临床评估预后及处理提供理论依据,提高认识、及早诊断对临床具有重要指导价值。     

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.