Vena Caval Abnormalities Discovered During Dissection in the Anatomy Lab: Two Cadaveric Case Reports

Abstract

Intro Congenital abnormalities of the inferior vena cava (IVC) are rare in the general population with the incidence of IVC duplication being between 0.2 – 3%. Persistent left superior vena cava (SVC) has an incidence of 0.3 – 0.7%. It is important to identify such variations through imaging prior to various thoracic and abdominal surgeries to minimize peri‐operative complications. Methods Two cadavers with vena caval abnormalities were identified in a medical school cadaveric anatomy lab. The donor’s age, sex and cause of death were identified through bequeathal services. The pathway of the aberrant structures was identified through dissection and any tributaries along their courses were isolated. Surrounding structures were examined to identify any other concurrent abnormalities. Results We identified two cadavers with vena caval abnormalities. The first case was a 75‐year old female whose cause of death was a bowel obstruction with comorbid dementia. On this cadaver we identified a persistent left SVC that originated from the brachiocephalic vein on the left side that measured 19 mm in diameter. The aberrant structure drained into the right atrium via the coronary sinus, which was noticeably enlarged. The second case was a 76‐year old female whose cause of death was multiorgan failure with comorbid end stage liver failure, pulmonary edema and hypothyroidism. We identified a duplicated IVC with a diameter of 12 mm originating at the left iliac vein and draining into the left renal vein. Along the duplicated IVC were multiple branches originating from the posterior abdominal cavity. Conclusion We present here two cases with rare vena caval abnormalities found in cadavers in our anatomy lab. The embryological origin of a duplicated IVC stems from the persistence of both left and right supracardinal veins during development. A persistent left SVC occurs when the left superior cardinal vein fails to regress inferior to the brachiocephalic vein. Although rare, recognizing these anatomical variations bears clinical relevance, especially in a surgical setting. These abnormalities are important to identify pre‐operatively to avoid unexpected peri‐operative complications.