Inferior vena cava duplication: Demonstration by sonography

Abstract

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).

An unusual cause of lumbar pain after physical exercise: Caval vein duplicity and its detection by ultrasound

“…While in the past anatomical entities like IVC duplicities were recognized only during operative procedures on the retroperitoneum, in recent years pre-operative diagnoses are even more common [9,10], thanks to Computed Tomography (CT) scans and Ultrasound (US) examinations.…”

“…With the abdominal gray-scale sonogram in transverse plane, 2 paired anechoic and apparently cystic structures can be appreciated on either side of abdominal aorta [9] but in coronal or sagittal sections the tubular structure can be shown together with the course of IVC segments (Fig. 1).…”

Approach to the educational opportunities provided by variant anatomy, illustrated by discussion of a duplicated inferior vena cava

“…When clinically warranted, the diagnosis may require additional diagnostic maneuvers. Ultrasound is helpful in that easily obtained sagittal, coronal, and oblique views of the abdomen may reveal its tubular nature with the added benefit of flow studies (Richardson et al, 1983). Magnetic resonance imaging may show flow voids in similarly oriented views (Arisawa et al, 1999).…”