CASE 7544 Published on 23.05.2009

Left-positioned Inferior Vena Cava

Section

Cardiovascular

Case Type

Anatomy and Functional Imaging

Authors

Gori G, Centi A, Galeotti S, Iacconi C, Caramella D.

Patient

70 years, female

Clinical History
A 70 year old woman, who has had anexiectomy for ovarian adenocarcinoma, underwent thoracic and abdominal follow-up CT.
Imaging Findings
Two years ago, the patient underwent left adnexectomy for ovarian adenocarcinoma, metastasectomy of the second and sixth hepatic segments, resection of peritoneal carcinosis nodules and cholecystectomy (for adhesions).
Follow up CT showed stability of the note hepatic focalities without local relapses or new thoracic or abdominal repetitions.
Collaterally we observed a vascular anatomical variant with left-positioned Inferior Vena Cava (IVC). The IVC, after the confluence of the left venal vein, passes anteriorly to the abdominal aorta, positioning on the right of the aorta. This passage takes place caudally to emergence of the inferior mesenteric artery (Fig 1,2).
Discussion
Variants of the Inferior Vena Cava (IVC) are found in more than the 3% of the patients. The IVC forms between the 6th and the 8th week of embryonic life essentially from the development and subsequent regression of three pairs of veins: the posterior cardinal, the subcardinal and the supracardinal veins.
The foetal venous circulation is based on the cardinal veins system, which ensures the return of the venous blood the hearth.
The origin of the IVC is quite complex. The hepatic segment of IVC derives from the vitelline vein. The suprarenal tract derives from the left subcardinal vein. The renal segment originates from the anastomosis between the supracardinal and the postcardinal vein. The infrarenal tract is accepted to derive from the supracardinal vein.
The left position of IVC is caused by the regression of the right supracardinal vein instead of the left one. This vascular anomaly has a prevalence of 0.2-0.5%.
In CT and MRI axial images it is possible to see a single IVC which, above the renal vein, is positioned on the right, then crosses anteriorly (as in our case, see schematic in Fig 3) or posteriorly the aorta at the level of renal veins and sets itself on the left of the rachis under the renal veins.
Usually the left-positioned IVC is an incidental finding, but its identification is important for radiologist because vascular anomalies can be confused with adenopaties but also for surgeons in presurgical planning, preventing possible iatrogenic lesions.
Differential Diagnosis List
Incidental finding of Left-positioned Inferior Vena Cava in oncological patient.
Final Diagnosis
Incidental finding of Left-positioned Inferior Vena Cava in oncological patient.
Case information
URL: https://www.eurorad.org/case/7544
DOI: 10.1594/EURORAD/CASE.7544
ISSN: 1563-4086