A case of thoracic esophageal cancer with an unusual type of duplicated inferior vena cava

Abstract

We describe here a thoracic esophageal cancer with an unusual type of duplicated inferior vena cava. A 58-year-old man was referred to our hospital because a tumor in his lower esophagus had been identified by endoscopy and radiology. Computed tomography scans showed an unusual type of duplicated inferior vena cava characterized by both common iliac veins flowing back into the left-sided inferior vena cava, which drained into the azygos vein, whereas the right-sided one had no drainage. Esophagectomy was performed 3 weeks later after preoperative chemotherapy. Because the patient could have developed thrombosis of the left-sided inferior vena cava and severe hypotension caused by decreased venous return to the heart if the azygos vein had been severed, the azygos vein was preserved. Thus, when performing surgery for thoracic esophageal cancer, the surgeon should check for a duplicated inferior vena cava and preserve the azygos vein if necessary.

Case Report: Esophagectomy and Azygos Continuation of the Inferior Vena Cava: A Lethal Combination

“…Considering the unremarkable physical examination and laboratory test results of patients with such an anomaly, recognition of the warning signs (enlarged azygos vein and arch of the azygos vein) of this anomaly as visualized on preoperative CT and during intraoperative exploration is vital. To date, there have been only six reported cases of azygos continuation of the IVC in patients undergoing esophagectomy ( 2 – 4 , 6 ) ( Table 1 ). Three patients were safely discharged with adequate arch of azygos vein protection ( 3 , 4 ).…”

Oesophagectomy in a patient with azygos vein continuation of the inferior vena cava: report of a case

“…Shintakuya et al [ 3 ] have reported one case in which oesophagectomy was performed on a patient with a duplicated IVC, and azygos vein variation was identified by preoperative CT. Therefore, during oesophageal carcinoma surgery for patients with azygos vein variation, it is extremely important to maintain the integrity of the azygos vein.…”