Possible misinterpretation on computed tomography of left inferior vena cava as retroperitoneal lymph node metastasis: A report of two cases

Abstract

Purpose: We report on two cases of retroperitoneal lymph node metastasis of testicular cancer with left inferior vena cava. Methods/Results: A 25-year-old man with a left testicular cancer with pulmonary and retroperitoneal lymph node metastases received three courses of VIP (etoposide, ifosfamide and cisplatinum) chemotherapy. Subsequent abdominal computed tomography (CT) revealed round lesions enhanced with contrast agent on both sides of the aorta inside the degenerated lymphadenopathy. These lesions were regarded as a duplicated inferior vena cava (IVC) and this was confirmed at retroperitoneal lymph node dissection. The second case is of a 21-year-old man with a left testicular cancer with pulmonary, liver and widespread lymph node metastases. Subsequent to a course of VIP chemotherapy, super high-dose chemotherapy was administered. Abdominal CT revealed a round mass enhanced with contrast agent on the left side of the aorta adjacent to the degenerated lymphadenopathy, which was regarded as the transposed left IVC and this was confirmed at lymph node dissection. Conclusions:In both cases, initial CT failed to detect the lesions as the left IVC and there was a possibility for the misinterpretation of such venous anomalies with residual lymphadenopathy.

Anomalies of the inferior vena cava and renal veins and implications for renal surgery

“…The risk of vascular injury is even higher if not identified prior to surgery or when the right renal vein crosses posterior to the aorta [9]. A left IVC can also be misdiagnosed as lymphadenopathy and cases exist in the literature where lymph node dissection has been attempted or chemotherapy administered [10]. Figures 2a and 2b display transverse and coronal CT images of a patient with left IVC.…”

Left‐sided and duplicate inferior vena cava: A case series and review

“…Left‐sided and duplicate IVC are clinically important for several reasons: Potential misdiagnosis as lymphadenopathy on ultrasound or CT imaging (Evans et al, ; Castillo et al, ). This has even led to unnecessary chemotherapy (Arisawa et al, ). Technical difficulties during abdominal surgery , particularly retroperitoneal surgery. The abnormal position of the IVC and/or its association with supernumerary renal veins and anomalous tributaries (Ito et al, ; Byler et al, ) complicate dissection and increase the risk of hemorrhage (Aljabri et al, ; Nishibe et al, ; Kumar et al, ).…”

Double inferior vena cava with three shunts: a rare anomaly with important implications for surgeons

“…The potential for misdiagnosis on imaging may occur, leading to unnecessary treatment [2]. The surgeons should be aware of such variation of the IVC when performing surgical procedures in retroperitoneal region such as laparoscopic nephrectomy or donor nephrectomy [6,20].…”