Isolated Anomalous Inferior Vena cava with Azygos Drainage

Ramsaran, Eddison; Filiberti, Allen; Spodick, David H.

doi:10.1159/000176884

Cited by 12 publications

(13 citation statements)

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“…Van Praagh et al [7] reported an interrupted IVC in 39 of 46 (85%) postmortem cases of visceral heterotaxy with polysplenia. But, isolated ınterrupted IVC with azygos continuation has been rarely described [8][9][10], comparable with the case we report.…”

Section: Discussionsupporting

confidence: 90%

Isolated interrupted inferior vena cava with azygos continuation mimicking paraesophageal lymph node enlargement

Yılmaz

Halilçolar

Ünsal

et al. 2016

Monaldi Arch Chest Dis

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Azygos vein dilation has been described in patients with portal vein hypertension, obstruction of superior or inferior vena cava, right heart failure and interruption of the inferior vena cava (IVC). Interrupted IVC with azygos continuation is a rare clinical condition but in this situation, the azygos system dilates to accommodate visceral and lower the extremity of blood return to the right atrium. Although uncommon, these anomalies have been described as an isolated finding and can mimic a mediastinal mass [1,2,3,4]. If isolated interrupted IVC with azygos continuation is together with lung carcinoma, it can be misinterpreted as a lymphadenopathy in a patient who has been evaluated with unopacified CT scans.We present a case of isolated azygos continuation of the interrupted IVC mimicking a paraesophageal lymph node enlargement in a patient with a left hilar mass. Case reportA 68-year-old man was admitted to our hospital presenting a left tumour mass and lymphadenopathy on unopacified Computed Tomography scan of the chest and metastasis of the first and fourth lumbal vertebrae on Magnetic Resonance Imaging. The physical examination revealed a non-healthy man. He was febrile (37.5°C) and had a blood pressure of 150/100 mmHg, a heart rate of 100 beats/min. Breath sounds were diminished on both lungs. The heart and abdominal examinations were unremarkable. The neurological examination was significant for paralysis in both lower extremities. A posteroanterior chest x-ray revealed a left hilar mass. Contrast-enhanced spiral CT scan of the chest showed a tumour mass at the superior segment of the lower left lobe with invasion of the descending aorta and dilated azygos vein (figure 1), mild enlargement of the arch of the azygos, and enlargement of the retrocrural portions of these same veins in the absence of definable inferior vena cava (figure 2). Coronal (figure 3) and sagittal reconstructions showed that the azygos vein was as large as the descending aorta.Fiberoptic bronchoscopy showed no endobronchial lesion except of narrowing and mucosal hyperemia of the superior segment of the lower left lobe. The cytopathologic examination of the brushing and washing specimens was benign.In a routine ultrasound examination of the abdomen, the stomach, heart, liver and spleen were normally positioned and the gallbladder was present. A detailed ultrasound examination of the IVC was not carried out owing to the patient's poor health.Diagnosis of our patient was accepted to be lung carcinoma with bone metastasis and palliative radiotherapy planned. However, our patient did not accept the treatment and was discharged. DiscussionThe azygos vein usually originates below the diaphragma at the level of the first two lumbal verKeywords: Azygos vein, vascular anomaly, mimicking lymph node.

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Section: Discussionsupporting

confidence: 90%

Isolated interrupted inferior vena cava with azygos continuation mimicking paraesophageal lymph node enlargement

Yılmaz

Halilçolar

Ünsal

et al. 2016

Monaldi Arch Chest Dis

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“…A dilated azygos vein simulating a mediastinal tumor has been reported [4, 5, 6]. Isolated azygos continuation of the IVC with no associated congenital anomalies has also been reported [7, 8]. Our patient exemplifies the presentation of isolated azygos continuation of the IVC.…”

Section: Introductionsupporting

confidence: 66%

Isolated Azygos Continuation of the Inferior Vena cava in the Elderly

Fernandes

Israel²

2000

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“…Interrupted IVC can cause procedural difficulties during right heart catheterization, 6) electrophysiological studies (EPS), 4) cardiopulmonary bypass surgery, femoral vein catheter advancement, IVC filter placement, and temporary pacing through the transfemoral route, 3) if not identified before the procedure. Moreover, it can lead to life-threatening complications during abdominal surgery, because ligation of the azygos vein, the only major route of venous drainage from below the diaphragm, results in death.…”

Section: Discussionmentioning

confidence: 99%

“…5) The condition can lead to procedural difficulties and complications during abdominal surgery or catheter intervention that can be life-threatening, if not identified before the procedures. 3,4,6) Therefore, an awareness of this anomaly before the procedures is very important, especially if it coexists with congenital cardiac malformation.…”

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confidence: 99%

Successful Blood Sampling Through Azygos Continuation With Interrupted Inferior Vena Cava A Case Report and Review of the Literature

et al. 2011

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SummaryInterrupted inferior vena cava (IVC) with azygos continuation is a rare congenital anomaly, and is frequently associated with other cardiovascular malformations and situs anomalies, such as left isomerism. These patients usually develop deep vein thrombosis (DVT), and asymptomatic patients above 60 years of age are very rare. Here we report a case of interrupted IVC which we diagnosed in a 72-year-old woman. She was admitted to our hospital suffering from heart failure and supraventricular tachycardia. Echocardiography detected secundum atrial septal defect (ASD). An abnormal paravertebral pleural line on the chest X-rays indicated the existence of venous anomaly. Anatomical images obtained by Multidetector Computed Tomography (MDCT) helped us to successfully perform right heart catheterization procedures through azygos continuation including blood sampling from pulmonary veins. Even in elderly patients, a careful examination of chest X-rays can indicate undiagnosed venous anomalies; thus, it is critically important before planning surgical or interventional procedures. (Int Heart J 2011; 52: 327-330) Key words: Interrupted inferior vena cava, Left isomerism, Atrial septal defect, Heart failure I nterrupted IVC with azygos continuation is a rare congenital anomaly, resulting from aberrant development of the IVC segment during embryogenesis. 1) This developmental anomaly results in termination of the IVC below the hepatic vein. Systemic venous flow beyond this point is accommodated by dilated azygos and hemiazygos veins, which eventually empty into the superior vena cava (SVC) through a dilated azygos arch. 2)This anomaly is usually associated with recurrent DVT of the lower limbs 3) or with sick sinus syndrome 4) and it is typically detected in the early to middle ages of life (range, 14-56 years, mean, 34.5 ± 13.35 years). 5)The condition can lead to procedural difficulties and complications during abdominal surgery or catheter intervention that can be life-threatening, if not identified before the procedures.3,4,6) Therefore, an awareness of this anomaly before the procedures is very important, especially if it coexists with congenital cardiac malformation.Here we report the case of a 72-year-old woman with an interrupted IVC with azygos continuation accompanied by mild secundum ASD. An abnormal paravertebral pleural line on the chest X-rays helped us to detect this venous anomaly, and MDCT angiography confirmed the total interruption of IVC below the hepatic vein with azygos continuation. These anatomical images helped us to successfully achieve right heart catheterization through azygos continuation procedures including blood sampling. Case ReportA 72-year-old Japanese woman was admitted with complaints of exertional dyspnea. She had received a diagnosis of paroxysmal supraventricular tachycardia at the age of 63 years, but had no diagnosis of cardiac anomaly.On physical examination, fixed split of second heart sound and systolic ejection murmur were heard over the left side of the sternal border. ECG...

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Isolated Anomalous Inferior Vena cava with Azygos Drainage

Cited by 12 publications

References 5 publications

Isolated interrupted inferior vena cava with azygos continuation mimicking paraesophageal lymph node enlargement

Isolated interrupted inferior vena cava with azygos continuation mimicking paraesophageal lymph node enlargement

Isolated Azygos Continuation of the Inferior Vena cava in the Elderly

Successful Blood Sampling Through Azygos Continuation With Interrupted Inferior Vena Cava A Case Report and Review of the Literature

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