RESUMEN
Intrahepatic interruption of the inferior vena cava (IVC) with continued hemizygous is a very rare abnormality and sometimes it may be accompanied by other cardiovascular abnormalities. Continuation of the hemizygous vein draining into the right atrium through the left superior vena cava (LSVC) is much rarer. In this paper, we have presented a patient who had simultaneous IVC interrupted with persistent LSVC and suffered from Atrioventricular nodal reentrant tachycardia (AVNRT). Finally, radiofrequencies (RF) catheter ablation for AVNRT was successfully performed through a left subclavian vein access.
Asunto(s)
Ablación por Catéter , Vena Cava Superior Izquierda Persistente , Taquicardia por Reentrada en el Nodo Atrioventricular , Vena Cava Inferior , Adulto , Femenino , Humanos , Vena Ácigos/anomalías , Vena Ácigos/cirugía , Ablación por Catéter/métodos , Vena Cava Superior Izquierda Persistente/cirugía , Vena Cava Superior Izquierda Persistente/complicaciones , Taquicardia por Reentrada en el Nodo Atrioventricular/cirugía , Taquicardia por Reentrada en el Nodo Atrioventricular/fisiopatología , Vena Cava Inferior/anomalías , Vena Cava Inferior/cirugía , Vena Cava Superior/anomalías , Vena Cava Superior/cirugíaRESUMEN
Congenital anomalies of respiratory system are quite diverse and not all of them are subject to surgical treatment. One example is accessory lobe of the azygos vein. This anomaly usually has no clinical manifestations and requires only follow-up, as well as attention in surgery on the right half of the chest for some other disease. This situation changes when complications occur, for example, purulent-inflammatory process. Therapy is not always effective, and lung tissue destruction requires surgical treatment. Progressive destruction complicates diagnosis and choosing surgical tactics. We present a rare case of severe purulent-inflammatory complication with abscess in accessory lobe of v. azygos. Anatomical abnormalities following this congenital pulmonary anomaly can cause difficulties in surgeries for other intra-thoracic diseases. The situation is especially relevant for thoracoscopic access. This report will be useful for radiologists, pulmonologists and thoracic surgeons.
Asunto(s)
Vena Ácigos , Humanos , Vena Ácigos/cirugía , Vena Ácigos/anomalías , Resultado del Tratamiento , Masculino , Tomografía Computarizada por Rayos X/métodos , Toracoscopía/métodos , Pulmón/cirugía , Pulmón/anomalías , Pulmón/irrigación sanguínea , Pulmón/diagnóstico por imagen , Femenino , Absceso Pulmonar/cirugía , Absceso Pulmonar/diagnóstico , Absceso Pulmonar/etiologíaRESUMEN
The isolated absence of the azygos vein was incidentally found on computed tomography (CT) examination in a 60-year-old female. The exact anomaly can be evaluated on high-resolution images of 0.4-mm slice thickness with low keV using photon-counting detector CT. The azygos vein, including the azygos arch, was absent, and a mildly dilated hemiazygos vein flowed to the left brachiocephalic vein through the left superior intercostal vein. A hemiazygos vein connected the left renal vein at the level of the first lumbar vertebra. This patient was the second patient to undergo evaluation using volume rendering images. High-resolution maximum-intensity projection images were useful for assessing the anatomy. Radiation dose was decreased compared with that in conventional CT.
Asunto(s)
Vena Ácigos , Tomografía Computarizada por Rayos X , Humanos , Vena Ácigos/diagnóstico por imagen , Vena Ácigos/anomalías , Femenino , Persona de Mediana Edad , Tomografía Computarizada por Rayos X/métodos , Fotones , Hallazgos Incidentales , Dosis de Radiación , Venas Renales/diagnóstico por imagen , Venas Renales/anomalíasRESUMEN
Background: Segmental aplasia of the caudal vena cava (CVC) with azygos continuation is a congenital malformation macroscopically described in mammals including humans, dogs, and rodents. It is usually detected as an incidental finding and the final diagnosis is reached by computed tomography (CT), fluoroscopy, or post-mortem dissection. Case Description: A 3-year-old guinea pig (Cavia porcellus) presented with subacute dyspnea. A computed tomographic examination was performed for the evaluation of subtle pulmonary changes previously suspected on conventional radiography, and a segmental aplasia of the CVC with azygos continuation was identified as an incidental finding. Conclusion: According to database negative results, this is the first report describing a segmental aplasia of the CVC and azygos continuation in a guinea pig by CT.
Asunto(s)
Vena Ácigos , Tomografía Computarizada por Rayos X , Vena Cava Inferior , Animales , Tomografía Computarizada por Rayos X/veterinaria , Cobayas , Vena Ácigos/anomalías , Vena Ácigos/diagnóstico por imagen , Vena Cava Inferior/anomalías , Vena Cava Inferior/diagnóstico por imagen , Hallazgos Incidentales , Masculino , FemeninoAsunto(s)
Vena Ácigos , Enfermedades de los Perros , Riñón , Vena Cava Inferior , Animales , Perros , Vena Cava Inferior/anomalías , Vena Cava Inferior/diagnóstico por imagen , Enfermedades de los Perros/congénito , Enfermedades de los Perros/diagnóstico por imagen , Enfermedades de los Perros/cirugía , Riñón/anomalías , Vena Ácigos/anomalías , Vena Ácigos/diagnóstico por imagen , Masculino , Vena Porta/anomalías , Vena Porta/diagnóstico por imagen , FemeninoAsunto(s)
Anomalías Múltiples , Vena Ácigos , Cardiopatías Congénitas , Proteínas de Dominio T Box , Adulto , Femenino , Humanos , Embarazo , Anomalías Múltiples/genética , Anomalías Múltiples/diagnóstico por imagen , Vena Ácigos/anomalías , Vena Ácigos/diagnóstico por imagen , Cardiopatías Congénitas/genética , Cardiopatías Congénitas/diagnóstico por imagen , Defectos del Tabique Interatrial/genética , Defectos del Tabique Interatrial/diagnóstico por imagen , Defectos del Tabique Interatrial/cirugía , Deformidades Congénitas de las Extremidades Inferiores/genética , Deformidades Congénitas de las Extremidades Inferiores/diagnóstico por imagen , Mutación , Proteínas de Dominio T Box/genética , Ultrasonografía Prenatal , Deformidades Congénitas de las Extremidades Superiores/genética , Deformidades Congénitas de las Extremidades Superiores/diagnóstico por imagenRESUMEN
Inferior vena cava (IVC) interruption with azygos/hemiazygos continuation is an extremely uncommon congenital vascular anomaly, which may present with multiple variants. As a result, it is challenging to find in the literature the same anatomical variant. We report a unique case of an interrupted IVC with hemiazygos and transhepatic continuation in an 83-year-old female patient. The case was evaluated by performing Computed Tomography (CT) as imaging modality, with a multiphase protocol, able to detect accurately this complex vascular anomaly. The purpose of this case report is not only to present this remarkable case but also to briefly show the types of interrupted IVC, starting from the anatomy and the embryology of the IVC and the azygos system, and to discuss the value of imaging in detecting the vascular anomaly.
Asunto(s)
Cardiopatías Congénitas , Malformaciones Vasculares , Femenino , Humanos , Anciano de 80 o más Años , Vena Cava Inferior/diagnóstico por imagen , Vena Cava Inferior/anomalías , Vena Ácigos/diagnóstico por imagen , Vena Ácigos/anomalías , Tomografía Computarizada por Rayos X , Malformaciones Vasculares/diagnóstico por imagenRESUMEN
Congenital heart disease comprises one of the largest groups of congenital defects, affecting approximately 1% of births. Advances in pre- and postoperative critical care treatment as well as surgery and interventional procedures have improved survival rates, but treatment and long-term care of children with complex congenital heart disease remains challenging, and is associated with a number of complications.Here, we report on a 17-month-old infant with congenital univentricular heart disease who devloped post-operatively inferior vena cava (IVC) thrombosis. IVC thrombosis was confirmed by a bedside contrast media study (X-ray) demonstrating collateral paravertebral circulation along the paravertebral sinuses bilaterally into the azygos and hemiazygos vein ("rope ladder sign"), with no contrast media detected in the IVC. The infant was subsequently started on aspirin and clopidogrel.
Asunto(s)
Cardiopatías Congénitas , Trombosis de la Vena , Niño , Lactante , Humanos , Vena Cava Inferior/diagnóstico por imagen , Vena Cava Inferior/anomalías , Vena Cava Inferior/cirugía , Trombosis de la Vena/diagnóstico por imagen , Trombosis de la Vena/cirugía , Vena Ácigos/anomalías , Circulación ColateralRESUMEN
We present a case of intestinal malrotation with an absent inferior vena cava, which was found in a cadaver during a dissection course in our medical school. The intestinal malrotation was Amir-Jahed type 2, with the large intestine on the right side and the small intestine on the left side of the abdominal cavity. The descending colon was fixed on the right side of the posterior abdominal wall and continued into the pelvic cavity from the right side. The cadaver also had a venous system anomaly. The pre-renal segment of the inferior vena cava, which is a section between the renal vein and the hepatic vein, was absent. The inferior vena cava connected to the azygos vein after being joined by bilateral renal veins. The only hepatic segment of the inferior vena cava, which was posterior to the liver and received hepatic veins, penetrated the diaphragm and flowed into the right atrium. To our knowledge, this is the first report of these two anomalies appearing concurrently. We discuss the details of this case and the embryological considerations.
Asunto(s)
Hígado , Vena Cava Inferior , Humanos , Vena Cava Inferior/diagnóstico por imagen , Vena Cava Inferior/anomalías , Venas Renales , Vena Ácigos/anomalías , CadáverRESUMEN
INTRODUCTION: Situs inversus totalis, dextrocardia with interrupted inferior vena cava, and azygos vein continuation concomitant with symptomatic atrial fibrillation requiring ablation. This case was deemed not suitable for percutaneous ablation due to anatomic variations and the lack of case reports in the literature. METHODS AND RESULTS: We performed bilateral thoracoscopic epicardial ablation and epicardial left atrial appendage exclusion. The direct vision allowed for a complete box lesion set with bipolar radiofrequency device. Patient remained in sinus rhythm at the 12-months follow-up. CONCLUSION: Surgical thoracoscopic epicardial ablation is safe and effective also in congenital defects. Multidisciplinary expertise can offer minimally invasive ablation treatments.
Asunto(s)
Fibrilación Atrial , Ablación por Catéter , Dextrocardia , Cardiopatías Congénitas , Situs Inversus , Fibrilación Atrial/complicaciones , Fibrilación Atrial/cirugía , Vena Ácigos/anomalías , Vena Ácigos/cirugía , Dextrocardia/complicaciones , Dextrocardia/cirugía , Cardiopatías Congénitas/cirugía , Humanos , Situs Inversus/complicaciones , Situs Inversus/cirugía , Vena Cava Inferior/anomalías , Vena Cava Inferior/cirugíaAsunto(s)
Vena Ácigos/diagnóstico por imagen , Venas Pulmonares/diagnóstico por imagen , Malformaciones Vasculares/diagnóstico por imagen , Vena Ácigos/anomalías , Diuréticos/uso terapéutico , Disnea/etiología , Disnea/fisiopatología , Várices Esofágicas y Gástricas/complicaciones , Femenino , Furosemida/uso terapéutico , Hepatitis C/complicaciones , Humanos , Hipertensión Pulmonar/complicaciones , Cirrosis Hepática/complicaciones , Cumplimiento de la Medicación , Persona de Mediana Edad , Terapia por Inhalación de Oxígeno , Enfermedad Cardiopulmonar/complicaciones , Enfermedad Cardiopulmonar/tratamiento farmacológico , Venas Pulmonares/anomalías , Insuficiencia Respiratoria/complicaciones , Insuficiencia Respiratoria/terapia , Fumar , Abuso de Sustancias por Vía Intravenosa/complicaciones , Tomografía Computarizada por Rayos X , Malformaciones Vasculares/complicaciones , Malformaciones Vasculares/fisiopatologíaRESUMEN
BACKGROUND: With the popularization of thoracoscopic surgery, more and more macrovascular malformations have been reported. Understanding some vascular malformations with relatively fixed anatomical site and their range of drainage could avoid severe complications during the surgery. Persistent left superior vena cava (PLSVC) is a common thoracic vascular malformation, and is always combined with other cardiovascular dysplasia. As for the patient with upper left lung cancer in this case, he had PLSVC and left azygos vein, and non-metastatic enlargement of the lymph nodes at the same time, which had influenced the decisions on surgery and treatment. We made a summary of experience regarding this. CASE PRESENTATION: A 46-years-old male patient, his CT found a space-occupying lesion in the superior lobe of the left lung. The chest CT showed that the patient had PLSVC and left azygos vein, and multiple enlarged lymph nodes in the mediastinum. The patient received thoracoscopic upper left lung lobectomy and lymph node dissection. It was discovered that the left azygos vein had a concealed form, which influenced the lymph node dissection. The post-surgery pathology showed that there was squamous cell carcinoma in the upper left lung (pT2bN0M0 p Phase IIA) and no cancer metastasis with the lymph nodes. The patient had a good post-surgery recovery. CONCLUSIONS: PLSVC is not rare, and is always combined with other vascular malformations. If discovering PLSVC before surgery, we suggest completing chest enhanced CT and vascular reconstruction, to find out other cardiovascular malformations that may exist. Left azygos vein is a rare vascular malformation, but it has a relatively fixed anatomical site, and always co-exists with PLSVC, therefore, understanding anatomy of left azygos vein is good for preventing accidental damage. Especially when performing surgery above the left pulmonary artery trunk, attention shall be paid to preventing damage to the left azygos vein. In addition, as for the patient with the diagnosis of lung cancer before surgery, it is not reliable to judge whether there is metastasis or not merely according to the size of the lymph nodes, instead, PET-CT or needle biopsy is recommended.
Asunto(s)
Vena Ácigos/anomalías , Carcinoma de Células Escamosas/diagnóstico , Neoplasias Pulmonares/diagnóstico , Vena Cava Superior Izquierda Persistente/diagnóstico , Vena Cava Superior/anomalías , Carcinoma de Células Escamosas/complicaciones , Carcinoma de Células Escamosas/diagnóstico por imagen , Carcinoma de Células Escamosas/cirugía , Diagnóstico Diferencial , Cardiopatías Congénitas/complicaciones , Cardiopatías Congénitas/diagnóstico , Cardiopatías Congénitas/diagnóstico por imagen , Cardiopatías Congénitas/cirugía , Humanos , Neoplasias Pulmonares/complicaciones , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/cirugía , Masculino , Persona de Mediana Edad , Vena Cava Superior Izquierda Persistente/complicaciones , Vena Cava Superior Izquierda Persistente/diagnóstico por imagen , Vena Cava Superior Izquierda Persistente/cirugía , Tomografía Computarizada por Tomografía de Emisión de Positrones , Tomografía Computarizada por Rayos XRESUMEN
Azygos system of veins is the main source of venous drainage from the thoracic wall. Knowledge of azygos vein anomalies could be of importance to cardiothoracic surgeons and radiologists. We report a rare variation of azygos vein as seen in an adult male cadaver aged 65 years approximately. The azygos vein was formed by the union of left ascending lumbar and subcostal veins. It coursed upwards on the left side of descending thoracic aorta and crossed the left subclavian artery and the left vagus to terminate into the left brachiocephalic vein. It received left superior intercostal vein and left fifth to eleventh posterior intercostal veins. The hemiazygos and accessory hemiazygos veins were situated on the right side of the vertebral column. They received the right posterior intercostal veins and terminated into the azygos vein at the level of eighth thoracic vertebra.
Asunto(s)
Variación Anatómica , Vena Ácigos/anomalías , Malformaciones Vasculares/diagnóstico , Anciano , Cadáver , Humanos , MasculinoAsunto(s)
Vena Ácigos/anomalías , Defectos del Tabique Interatrial/diagnóstico , Vena Cava Inferior/anomalías , Adulto , Vena Ácigos/diagnóstico por imagen , Vena Ácigos/cirugía , Diagnóstico Diferencial , Disnea/etiología , Ecocardiografía , Femenino , Vena Femoral , Cardiopatías Congénitas/complicaciones , Cardiopatías Congénitas/diagnóstico , Cardiopatías Congénitas/cirugía , Defectos del Tabique Interatrial/complicaciones , Defectos del Tabique Interatrial/diagnóstico por imagen , Defectos del Tabique Interatrial/cirugía , Humanos , Intervención Coronaria Percutánea , Vena Cava Inferior/diagnóstico por imagen , Vena Cava Inferior/cirugía , Grabación en VideoRESUMEN
The superior vena cava is formed during the fetal period by the development of anastomoses between the right and left anterior cardinal veins, and the regression of the central part of the left anterior cardinal vein. The persistence of this part of the left anterior cardinal vein causes the formation of a left superior vena cava, which is a rare anomaly in cadaver dissection. We report the case of a persistent left superior vena cava with a normal right superior vena cava in a 95-year-old male cadaver, which was discovered during anatomical dissection for medical students at Kawasaki Medical School in 2016. The left superior vena cava was formed by the confluence of the left internal jugular and left subclavian veins and terminated in the right atrium via what would normally be the coronary sinus. The right and left superior venae cavae received intercostal veins via a right and left azygos vein, respectively. However, the right azygos vein was shorter than the normal azygos vein and received only the second to fifth intercostal veins, whereas the left azygos vein received the fifth to eleventh left intercostal veins and the sixth to eleventh right intercostal veins. We consider that the anomalies of the azygos venous system were the result of regression of right supracardinal vein and the persistence of the left supracardinal vein during development. An awareness of such variations of major thoracic veins is important for the interpretation of unusual CT images.
Asunto(s)
Anomalías Múltiples , Vena Ácigos/anomalías , Seno Coronario/anomalías , Vena Cava Superior/anomalías , Anciano de 80 o más Años , Vena Ácigos/patología , Seno Coronario/patología , Humanos , Masculino , Vena Cava Superior/patologíaAsunto(s)
Anomalías Múltiples , Vena Ácigos/anomalías , Atresia Tricúspide/complicaciones , Vena Cava Superior/anomalías , Vena Ácigos/diagnóstico por imagen , Vena Ácigos/fisiopatología , Preescolar , Angiografía por Tomografía Computarizada , Angiografía Coronaria , Hemodinámica , Humanos , Masculino , Flebografía , Flujo Sanguíneo Regional , Atresia Tricúspide/diagnóstico por imagen , Atresia Tricúspide/fisiopatología , Vena Cava Superior/diagnóstico por imagen , Vena Cava Superior/fisiopatologíaRESUMEN
Patients with functionally single ventricle and interrupted inferior vena cava may develop progressive cyanosis soon after the Kawashima operation. Therefore, early redirection of the hepatic venous return to the pulmonary circulation is recommended. To avoid performing an early redo sternotomy, we propose to prepare these patients for the interventional Fontan-Kreutzer at the time of the Kawashima operation using a technical modification of the approach reported by Prabhu and coworkers in 2017. The technique described here uses an expanded polytetrafluoroethylene conduit interposed between the hepatic veins and the right pulmonary artery. This graft is everted and divided into two portions with a pericardial patch. The lower one is widely opened and anastomosed side-to-side to the atrium. A few months after the operation, percutaneous Fontan-Kreutzer completion can easily be performed using covered stents to open the patch and at the same time close the opening between the conduit and the atrium.
Asunto(s)
Malformaciones Arteriovenosas/diagnóstico , Vena Ácigos/anomalías , Procedimiento de Fontan , Puente Cardíaco Derecho , Ventrículos Cardíacos/anomalías , Vena Cava Inferior/anomalías , Malformaciones Arteriovenosas/diagnóstico por imagen , Malformaciones Arteriovenosas/cirugía , Vena Ácigos/cirugía , Femenino , Cardiopatías Congénitas/diagnóstico , Cardiopatías Congénitas/diagnóstico por imagen , Cardiopatías Congénitas/cirugía , Ventrículos Cardíacos/cirugía , Humanos , Lactante , Vena Cava Inferior/cirugíaRESUMEN
We describe the case of a term baby boy born via vaginal delivery at 39 weeks gestation with oesophageal atresia, tracheaoesophageal fistula, situs inversus abdominalis and azygos continuation. The azygos continuation was diagnosed after cardiac echo and confirmed on cardiac catherisation after an unexpected umbilical line position on thoracoabdominal X-ray. The baby underwent a right-sided thoracotomy on day 1 of life for repair of the oesophageal atresia. A double fistula, of both the proximal and distal segments, of the oesophagus with short segment stenosis was confirmed. The tracheo-oesophageal fistulae were ligated and divided and the oesophageal atresia repaired by primary anastomosis without complications. The azygos vein was not ligated.
Asunto(s)
Vena Ácigos/anomalías , Atresia Esofágica/complicaciones , Situs Inversus/complicaciones , Fístula Traqueoesofágica/congénito , Humanos , Recién Nacido , MasculinoRESUMEN
The azygos lobe is a rare congenital anomaly of the right upper lobe of the lung. There are few surgical cases that azygos lobectomy reported arise from an azygos lobe primary lung cancer in the literature. We share our treatment experience in our case who a 65-year-old male and he has a primary lung cancer arise from azygos lobe. Lung cancer surgery principiles for segmentectomy (azygos lobectomy) can be performed it by avoiding complications.