CT of congenital anomalies of the inferior vena cava

The authors report six congenital abnormalities of the inferior vena cava detected on computed tomography (CT). The CT findings of one of these, the left inferior vena cava, have not been previously reported. The embryology of the inferior vena cava and the possible congenital abnormalities that can occur are discussed. Congenital abnormalities of the inferior vena cava are rare but potentially important to the radiologist, the surgeon, and the patient. They are easily identified on CT and should be considered when interpreting any CT of the abdomen or chest.     

Leiomyosarcoma of the infrarenal portion of the inferior vena cava in a cirrhotic patient with hepatitis C

Leiomyosarcoma of the inferior vena cava is a rare primary tumor. We present a case of a 65-year-old man with the history of cirrhosis and non-specific symptoms. The patient underwent computed tomography and magnetic resonance imaging that revealed a leiomyosarcoma of the infrarenal portion of inferior vena cava. Clinical and imaging features, as well as the surgical technique of resection are discussed.     

Atrioventricular Nodal Tachycardia in a Patient with Anomalous Inferior Vena Cava with Azygos Continuation and Persistent Left Superior Vena Cava

A 39-year-old female patient was referred for ablation of recurrent episodes of atrioventricular nodal reentrant tachycardia. A combination of an anomalous inferior vena cava with azygos continuation and a persistent left superior vena cava was discovered. A nonfluoroscopic navigation system was very useful for catheter ablation of the tachycardia in this unusual case of anomalous venous system of the heart.     

Narrowing of the upper abdominal inferior vena cava in patients with elevated intraabdominal pressure: sonographic observations.

Focal narrowing of the upper intrahepatic inferior vena cava on computed tomography performed in patients with elevated intraabdominal pressure has been reported recently. The purpose of this study was to assess this phenomenon further with gray scale and duplex Doppler sonography. Seven patients with elevated intraabdominal pressure due to massive ascites in whom computed tomography showed narrowing of the intrahepatic inferior vena cava were studied. Sonography confirmed focal narrowing of the intrahepatic inferior vena cava that persisted throughout the respiratory and cardiac cycles. The narrowed inferior vena cava segment had a characteristic slitlike appearance on transverse images, slightly oblique to the sagittal plane. A focal flow jet typical of stenosis was observed in the three patients in whom Doppler sonography technically was feasible. In three of four patients who were able to sit or to turn into the left lateral decubitus position, the narrowing immediately resolved after the positional change but promptly recurred upon return to the supine position. In patients with elevated intraabdominal pressure, focal slitlike narrowing of the intrahepatic inferior vena cava is an anticipated finding that should not be misinterpreted as evidence of stenosis of the inferior vena cava or of a juxtacaval liver lesion.     

CT appearance of calcified tumor thrombus in the inferior vena cava

We report the unusual occurrence of calcined tumor thrombus in the inferior vena cava (IVC) in a patient with renal cell carcinoma diagnosed by computed tomography (CT).     

Embryogenetic malformations of the inferior vena cava, and their manifestations in adults

Five male patients with congenital anomalies of the inferior vena cava aged 20 to 43 were examined. The diagnosis and the level of aplasia were established on the basis of complex instrumental examination (duplex scanning of inferior extremity veins, pelvic veins, and retroperitoneal veins; computed and magnetic resonance tomography of the abdominal cavity; pelvic phlebography; retrograde cavagraphy). Together with inferior vena cava anomalies, other malformations such as pulmonary arterial stenosis or duplication of renal collector system were diagnosed in two patients. In three or 60% of the patients the disease had first manifested by the clinical picture of peripheral thrombosis (shin and femoral edema); fever, chill and subsequent edema of both legs had been first manifestations in two patients. Aplasia of the infrarenal segment of the inferior vena cava was revealed in two patients; in other two patients aplasia of the infrarenal, renal, and partly suprarenal segments of this magistral vessel was found; in one patient the whole vein was aplastic except a small part of the suprarenal segment, where the hepatic veins and the right suprapolar renal vein flew into. To establish an early diagnosis of a congenital inferior vena cava anomaly, the protocol of examination of patients with venous diseases should include ultrasound mapping of the suprarenal and infrarenal segments of the vena cava; in cases of agenesia it should include computed and magnetic resonance tomography and retrograde cavagraphy.     

Ureteral double J stent displaced into vena cava and management with laparoscopy: A case report and review of the literature

We reported displacement of a ureteral double J stent into the vena cava and laparoscopic management in a 69-year-old patient with a history of ureteral stent placement. Preoperative computed tomography and plain X-rays showed malpositioning of the double J stent and displacement into the inferior vena cava. The characteristics of stent misplacement precluded endovascular procedures and explorative laparoscopic surgery was performed. The intra- and postoperative periods were uneventful. Postoperative imaging demonstrated that the new double J stent was in the right position. The patient was discharged 7 d after the operation and was symptom free at the 4-mo follow-up.     

Preoperative intravascular ultrasonographic evaluation of leiomyosarcoma of the inferior vena cava: A case report

Leiomyosarcoma of the inferior vena cava is a rare malignant tumor originating from smooth muscle cells of the vascular media. Its preoperative diagnosis by conventional noninvasive examinations such as abdominal ultrasonography, X-ray computed tomography, and magnetic resonance imaging, may be difficult because of their nonspecific findings. We present the case of a 72-year-old woman with leiomyosarcoma of the inferior vena cava diagnosed by intravascular ultrasonography.     

Ruptured inferior vena cava aneurysm in the setting of mural vascular malformation: A case report

Aneurysm of the inferior vena cava is a rare anomaly with a very few reported cases worldwide. We report the case of a 26-years-old man with acute severe abdominal pain and hypovolemic shock following an episode of syncope. Ultrasonography showed a fusiform aneurysmal dilation of the infra-hepatic inferior vena cava (IVC), with a large saccular portion at its posterolateral wall and mural thrombosis. Abdominal computed tomography scan revealed extension to the right renal vein and adhesion to the right kidney. The saccular aneurysm and the right kidney were resected, and anatomopathological examination revealed a cavernous hemangioma. All symptoms disappeared after surgery. This is the first reported case of symptomatic congenital saccular aneurysm of the IVC due to mural vascular malformation and with involvement of the right kidney leading to nephrectomy.     

Primary leiomyosarcoma of the inferior vena cava: case report

The patient was a 63-year-old woman with a chief complaint of blood-stained sputum. A tumor of the inferior vena cava was found on chest computed tomography (CT) and identified as a primary tumor based on multidetector CT and contrast-enhanced MR angiography. An intrapelvic tumor was also discovered. On autopsy, the two tumors were diagnosed as leiomyosarcoma and ovarian fibroma, respectively.     

Side matters: An intriguing case of persistent left superior vena-cava

Persistent left superior vena cava, usually an incidental finding, is the most common thoracic vein anatomical variation draining into the coronary sinus. Central venous catheter procedures may be complicated secondary to the presence of a persistent left superior vena cava, leading to life-threatening complications such as arrhythmias, cardiogenic shock, and cardiac arrest. We present a case of persistent superior vena cava diagnosed on transthoracic echocardiogram (TTE) in a patient with congestive heart failure. A dilated coronary sinus was identified on TTE, followed by injection of agitated saline into the left antecubital vein resulting in filling of the coronary sinus prior to the right atrium-an indication of persistent left superior vena-cava. This also was confirmed on cardiac computed tomography. Such a diagnosis is critical in patients who may undergo central venous catheter procedures such as our patient’s potential requirement for an implantable cardiovertor defibrillator due to severe global left ventricular systolic dysfunction. The presence of a persistent left superior vena cava should always be suspected when the guidewire takes a left-sided downward course towards the right atrium at the level of the coronary sinus. Therefore, special attention should be paid to the imaging work-up prior to central venous catheter procedures.     

多层螺旋CT静脉血管成像价值探讨

目的探讨多层螺旋CT静脉血管造影的应用价值.方法收集不同部位CT静脉血管造影21例,颈静脉及门静脉系统血管造影由上肢静脉注入对比剂,下腔静脉及下肢造影由小隐静脉注入对比剂,行三维重建及多平面重建,结合临床资料分析血管成像技术及诊断价值.结果静脉血管CT造影表现不同于动脉CT造影,不同部位的静脉血管表现不同.21例中发现颈鼻咽癌侵犯血管1例,血管走行纡曲1例;下腔静脉瘤1例,肿瘤压迫下腔静脉1例;门静脉高压1例,疑肠系膜上静脉内血栓1例;11例下肢静脉血栓.结论不同部位的静脉影像表现存在差异,不同的重建技术对血管的显示有影响.下腔静脉造影应注意假象的存在.     

Congenital absence of the portal vein associated with focal nodular hyperplasia in the liver in an adult woman

We present a new case of congenital absence of the portal vein and focal nodular hyperplasia in the liver without additional congenital anomalies. Ultrasound, computed tomography, magnetic resonance imaging, and angiography depicted the splenic vein and the superior mesenteric vein joining and entering into the inferior vena cava without passing through the liver. The features of this patient and the 30 previously reported cases are reviewed.     

Computed tomography of hepatic venous hypertension: The reticulated-mosaic pattern

A reticulated-mosaic pattern of the liver was identified on contrast-enhanced computed tomography in 4 of 20 patients with constrictive pericarditis or congestive heart failure. Reflux of contrast into a distended inferior vena cava and the hepatic veins was identified in 3 of the 4 patients. This abnormal enhancement pattern combined with hepatic venous or caval reflux of contrast indicates the presence of hepatic venous hypertension, and should not be mistaken for other abnormalities that may result in inhomogeneous hepatic enhancement.     

Superior vena cava obstruction: is stenting necessary?

No therapy is currently available for patients with recurrent vascular obstruction of the superior vena cava (SVC) caused by tumor regrowth after chemotherapy or radiation therapy. Intravascular stenting is a new option for the treatment of vena cava syndrome. Forty cancer patients with SVC syndrome (SVCS) were evaluated by computed tomography (CT) and venography. The SVC or its tributaries were stenosed or thrombosed in all patients. The etiology was malignant in all but 2 cases: non-small-cell lung carcinoma (n = 28), mediastinal nodal metastasis (n = 5), lymphoma (n = 2), pleural mesothelioma (n = 2), small-cell lung carcinoma (n = 1), and postradiation fibrous mediastinitis (n = 2). Stenting was achieved in 39 of the 40 patients, and clinical symptoms subsided in 92%. Stents remained patent in 36 of these 39 patients throughout a mean follow-up of 24 weeks (range 3 days to 24 months). SVC stenting is safe, effective and allows rapid cure of SVCS and port catheter implantation in patients in poor health.     

Venous thromboembolism in trauma: an update for the intensive care unit practitioner

Venous thromboembolism (VTE) in trauma patients is a capricious problem that continues to plague trauma surgeons and critical care physicians alike. Pharmacologic preventions of VTE with anticoagulants are often contraindicated in the trauma patient because of risk of bleeding diathesis. Mechanical prophylaxis in the form of venous compression boots often cannot be placed because of external fixators, swelling, and so forth. Providing effective VTE prophylaxis, while at the same time providing definitive care for the trauma patient, can be a nightmare. This review will first discuss the incidence and prevalence of VTE, as well as investigate the condition's diagnosis and treatment. Solutions to frequently encountered clinical dilemmas in managing VTE in trauma patients are considered in the form of frequently asked questions. Diagnostic techniques such as magnetic resonance venography, D-dimer, and various computed tomography methods are evaluated. Recent literature on preventive pharmacologic therapies is explored. The authors also consider whether vena cava filters prevent pulmonary embolism in trauma patients.     

Transvenous Pacemaker Implantation Via a Unilateral Left Superior Vena Cava

A 72-year-old man with a unilateral left superior vena cava and anomalous drainage of the inferior vena cava required permanent pacing. The anomalies were verified by venography and cardiac catheterization. Difficulties in implantation of a temporary and permanent pacemaker are described. A transvenous endocardial lead was placed in a stable position in the right ventricle. The pacemaker system has now functioned normally for 32 months.     

CT appearance of transposition of the inferior vena cava

Four cases of transposition of the inferior vena cava were recently examined by computed tomography (CT). The CT appearance of this entity is discussed. Knowledge of such an anomaly can prevent misinterpretation and surgical complications.     

Case report of double superior vena cava and double odd vein with hypoplastic left brachiocephalic vein

Persistent left superior vena cava (PLSVC) is a common venous variation that is usually accompanied by an absence of the left brachiocephalic vein, and displays a higher incidence in patients with congenital heart disease. Here, the case of a 57-year-old male patient who was found to have PLSVC on chest computed tomography (CT) during screening for gastric cancer metastasis at the Affiliated Hospital of Qinghai University, is described. Further coronal CT and three-dimensional reconstruction of the chest revealed the patient''s double superior vena cava (DSVC), double odd veins, and left brachiocephalic vein dysplasia. The patient did not have congenital heart disease and the case was associated with dysplasia of the left brachiocephalic vein, indicating an unusual and rare venous abnormality. At the time of writing, the patient was receiving antitumour therapy.