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A 37-yr-old woman presented with pain in her left leg. Because of a clinical suspicion of deep vein thrombophlebitis, a contrast venogram was performed in this leg. Her deep leg veins were unremarkable on venography, but a double inferior vena cava (IVC) was noted on the views of her upper leg and abdomen (Fig. 1). She was then examined with abdominal sonography. A transverse scan 2 cm above the umbilicus ( Fig. 2A) showed paired cystic structures on either side of the abdominal aorta. These structures were also well visualized on longitudinal scans (Fig. 2B-D). Case 2A 58-yr-old man was found t o have an abdominal aortic aneurysm. Since he also had systemic hypertension, renal vein sampling for renin was performed to help assess the possibility of related renovascular hypertension. Following catheterization of the right femoral vein using the Seldinger technique, the right renal vein was catheterized and sampled without difficulty. The left renal vein, however, could not be identified. Contrast medium was injected into the IVC to help visualize the anatomy. This injection suggested the possibility of a duplicated IVC, so the left femoral vein was also catheterized using the Seldinger technique. Simultaneous injections of both sides confirmed that a duplication was present (Fig. 3). Sonography showed a 5-cm abdominal aortic aneurysm just anterior to the spine, with paired cystic structures seen on either side (Fig. 4).

This chapter, appearing in the section “Asymmetry, Mass, and Distortion,” will discuss the presence of tissue asymmetry visualized only on one view. The distribution of fibroglandular tissue is extremely variable and unique from one patient to another; however, in most patients the parenchyma is usually distributed within the breasts symmetrically in a “mirror-image” fashion. Areas of tissue density (asymmetry) may be seen that are only visualized on the craniocaudal (CC) or mediolateral oblique (MLO) view. In the majority of patients, this finding represents superimposed normal tissue, or islands of normal parenchyma. Occasionally, underlying benign lesions may present as a tissue asymmetry. Rarely, a one-view asymmetry may represent a malignancy. This section will discuss the imaging features (including mammography, tomosynthesis, and ultrasound assessment), clinical features, differential diagnosis, and management suggestions for one-view asymmetries.

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