Complete Duplication of Inferior Vena Cava Coexisting with Double Superior Vena Cava In Situ Solitus: Hitherto Unreported Pattern.

Congenital anomalies of inferior vena cava are increasingly being recognized with the technical advancements and increased utilization of cross-sectional imaging techniques. Duplication of inferior vena cava classically involves duplication of the infrarenal segment, where both inferior vena cava ascend on either side of the abdominal aorta until they form a confluence at the level of the renal veins. It has been extensively described in literature with few reports of more complex variation in the form of duplicated infrarenal inferior vena cava with azygos or hemiazygos continuation. This article describes extremely rare complete duplication of inferior vena cava involving both suprarenal and infrarenal segments. Moreover, the complete duplication of inferior vena cava is seen in association with concomitant double superior vena cava, in a patient with visceroatrial situs solitus and associated congenital heart disease, which to the best of our knowledge, has not been reported so far in literature. This study also highlights the utility of multidetector computed tomography in accurate identification of such anomalies.

Successful left ventricular lead placement by way of an azygos vein for a patient performing cardiac resynchronization therapy implantation with an occluded left subclavian vein: A case report.

Central venous obstruction following pacemaker implantation is not uncommon and can prove challenging in the case of a system upgrade to a cardiac resynchronization therapy pacemaker (CRT-P). We describe the case of a patient who underwent a successful upgrading procedure of a pacemaker to a CRT-P in the presence of an occluded left subclavian vein and superior vena cava, using collateral veins that drained into right atrium.

Dysphagia With Unusual Etiology: A Case Report.

Here, we present a case of dysphagia with a very unusual etiology. Dysphagia is a symptom of concern and can occur secondary to multiple etiologies. Therefore, prompt and appropriate evaluation is necessary, as treatment varies depending on the underlying cause. Our patient was a 73-year-old female admitted for dysphagia associated with recent significant weight loss and a history of long-term smoking. A CT scan of her neck revealed a mass that was compressing the esophagus, but the etiology of the mass was unexpected. This case highlights the importance of considering rare causes of dysphagia and underscores the need for physicians to be aware of them.

Cadaveric dissection of connection between accessory hemiazygos vein and left brachiocephalic vein.

PURPOSE: The azygos system of veins has many anatomical variations that can impact mediastinal and vascular interventions. While radiological reports on these are of great clinical value, this study is among the first to present a high-quality cadaveric dissection of a rare anatomical variant to supplement previously published radiologic studies. The azygos venous system consists of the azygos vein (AV), hemiazygos vein (HAV), and the accessory hemiazygos vein (AHAV), which develop from the last portion of the posterior cardinal veins. The normal anatomical configuration includes drainage of the posterior intercostal veins, vertebral vein, esophageal veins, HAV, and AHAV to an unpaired right-side AV at the level of the 8th/9th thoracic vertebra. The reported incidence of AHAV draining directly into the left brachiocephalic vein is 1-2%. METHODS: An adult formalin-fixed 70-year-old female cadaver was dissected as part of a medical gross anatomy elective course. RESULTS: Gross documentation of a direct connection of the HAV to the AHAV with the AHAV draining into the left brachiocephalic vein. CONCLUSION: It is important to note the variations of the azygos system to avoid confusion with a potential pathology such as mediastinal masses. Understanding of the rare variant reported here could be useful in the prevention of iatrogenic bleeding from the misplacement of venous catheters and help facilitate radiological diagnosis in the incidence of venous clot formation.

Hemiazygos vein dilation as a radiological finding and multifactorial cause of dysphagia.

Dysphagia is a common issue observed among the elderly, which can arise from various etiologies such as motility disorders and chronic neurologic conditions. Radiologists play a crucial role in diagnosing the cause of dysphagia, as they can identify anatomical abnormalities that may lead to the condition. One such anomaly is the hemiazygos vein, which is the left side equivalent of the azygos vein and can cause dysphagia if it crosses over the esophagus. To our knowledge, there are only 2 other recorded cases of azygos aneurysm/dilation causing esophageal dysphagia. In this context, we present a case report of a 73-year-old female with a 1-month history of weight loss and dysphagia due to a prominent hemiazygos vein. The case highlights the importance of thorough radiological evaluation in identifying the underlying cause of dysphagia and ensuring timely and appropriate treatment.

Bilateral inferior venae cava combined with the persistent left superior vena cava and hemiazygos continuation of left inferior vena cava with drainage into right atrium: A case report.

The persistent left superior vena cava (PLSVC) is a common venous abnormality. However, malformation of the bilateral inferior venae cava (IVC) is extremely rare, with an incidence rate of .3%. IVC malformation is associated most frequently with heart defects and isomerism and often has a poor prognosis. We presented a case of vascular malformations in the fetus of bilateral caval veins with the interruption of the left-sided venous return with hemiazygos continuation in presence of a right-sided inferior caval vein. Also noted were the PLSVC and a dilated right heart with a widened pulmonary trunk. In this case, there were no heart defects or chromosomal abnormalities, and the newborn postpartum was in a good condition.

Transhepatic balloon mitral valvotomy in mitral stenosis with interrupted inferior vena cava.

A 38-year-old female was found to have severe mitral stenosis, severe pulmonary arterial hypertension with moderate tricuspid regurgitation, dilated right atrium, persistent left superior vena cava, and hugely dilated coronary sinus. The scheduled balloon mitral valvotomy via trans-femoral approach was abandoned after the venogram revealed the presence of left-sided inferior vena cava with hemi-azygos continuation draining into coronary sinus via left-sided superior vena cava. Balloon mitral valvotomy was attempted from the right trans-jugular route, but we were unable to puncture the inter-atrial septum due to the hugely dilated coronary sinus and right atrium. A transhepatic approach was used and balloon mitral valvotomy was successfully done with a standard balloon of 24 mm size without any complication. In patients with inferior vena cava anomalies or interruption, a percutaneous transhepatic approach is a feasible alternative for performing balloon mitral valvotomy.

Unique Medley of Cardinal Veins: Duplicated Superior and Inferior Venae Cavae With Left Renal Agenesis and Hemiazygos Continuation of Left Inferior Vena Cava With Drainage Into Left Atrium.

Congenital anomalies of the superior and inferior vena cava result from abnormal embryogenesis of cardinal veins. Duplication of superior vena cava (SVC) occurs in 0.3% of the general population of which only 8% drain into the left atrium. The prevalence of double inferior vena cava (IVC) is around 0.2-3%. The reported incidence of unilateral renal agenesis ranges from 1:1100 to 1:5000, and the association of double IVC with renal agenesis has been reported in only 11 cases in the literature. The conglomeration of such rare anomalies incidentally noted in a single patient is reported in this study. A 32-year-old man was referred to our department for Computed Tomography (CT) scan of the thorax. The patient was found to have dorsal kyphoscoliosis with hemivertebrae. The SVC was duplicated with the right SVC draining into the right atrium and the left SVC draining into the left atrium. The left kidney was not visualized in the abdomen. There was dual IVC with no intercommunicating interiliac vein. The right IVC maintained its normal course, while the left IVC continued as hemiazygos vein and joined left SVC in the thorax. Also noted was the aberrant origin of the right subclavian artery. This is the first reported case of combined superior and inferior vena caval anomalies along with left renal agenesis in a single patient in the literature. A review on the embryological basis is also described in this article.

Deep vein thrombosis in patient with left-sided inferior vena cava draining into the hemiazygos vein: A case report.

BACKGROUND: Abnormalities of the inferior vena cava (IVC) are uncommon, and in many cases they are asymptomatic. Even so, it is vital that clinicians be aware of such anomalies prior to surgery in affected individuals. In the present report, we describe a rare anatomical variation of the IVC. CASE SUMMARY: A 66-year-old male was admitted to the hospital due to deep vein thrombosis of the right lower extremity. Upon contrast-enhanced computed tomography imaging, we found that this patient presented with a case of left-sided IVC draining into the hemiazygos vein, while his hepatic vein was directly draining into the atrium. CONCLUSION: Cases of left-sided IVC can increase patient susceptibility to thromboembolism owing to the resultant changes in blood flow and/or associated vascular compression.

An abnormal course of the interazygos vein: a case report.

BACKGROUND: The azygos venous system in the posterior mediastinum has a complex developmental pattern. CASE PRESENTATION: During the dissection of this region, we encountered a variation in this system. In this case, we observed that the accessory hemiazygos and hemiazygos veins in the left side passed anterior to the aorta and drained to the azygos vein located on the left side of the vertebral column. Other structures were normal in this area. CONCLUSIONS: This variation is important in mediastinal surgery and radiographic interpretation.

Catheter Directed Thrombolysis for Pulmonary Embolism in Patients With Rare Inferior Vena Cava Variants.

INTRODUCTION: Congenital left inferior vena cava (IVC) with hemiazygos continuation and drainage into the superior vena cava (SVC) is a rare IVC variant and is associated with venous thrombo-embolism. This is the report of a case of hemiazygos continuation of the left IVC receiving catheter directed thrombolysis (CDT) for pulmonary embolism. REPORT: A 72 year old woman presented with progressive dyspnoea, and CT images confirmed the diagnosis of pulmonary embolism. The unusual route of the IVC was observed during the right heart catherisation and CDT. CDT was then performed with a left femoral venous approach. The patient tolerated the procedure well, and the follow up pulmonary angiogram showed no residual thrombus. DISCUSSION: The use of CDT for pulmonary embolism in patients with left IVC with hemiazygos continuation and drainage into the SVC has been reported rarely. Awareness of this diagnosis is critical during right heart catheterisation to prevent devastating complications. However, with careful manipulation, right heart catheterisation and CDT can be achieved successfully. Pulmonary embolism in patients with left IVC with hemiazygos continuation and drainage into the SVC can be treated with CDT safely and effectively with caution. It is wise to remember the different anatomical variations during IVC catheterisation.

Transposition and variant termination of azygos and hemiazygos veins: an extremely rare variation.

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.

A Case of Abnormal Origin of the Azygos Vein System: An Anatomical Study in a Human Cadaver.

The azygos vein (AV) system is considered a venous system which displays great variability in its formation and course. Especially, regarding the origin of the AV system, the international literature describes mostly the union of the ascending lumbar with the subcostal veins, though other origins are documented as well. The current study displays an abnormal origin of the azygos system, which to the best of our knowledge has never been described before.

Azygos and hemiazygos continuation: An occasional finding in emergency department.

Interruption of the inferior vena cava (IVC) with azygos continuation is a rare congenital anomaly, in which the IVC is interrupted below the hepatic vein and venous return beyond this point is restored by the dilated azygos and hemiazygos veins draining into the superior vena cava. A case of the interruption of the IVC with azygos/emyazygos continuation for the absence of the hepatic segment of IVC, left renal vein duplication, and polysplenia is reported. The embryologic, clinical, and radiological significance are discussed. The diagnosis is suggested by X-ray, but contrast-enhanced multidetector computed tomography is the method of choice to diagnose this venous anomaly and reveals the aberrant vascular structures. Awareness of different congenital anomalies of IVC is important to surgeons and cardiologists and is necessary for radiologists to avoid diagnostic pitfalls and for preoperative planning: they should be remembered because they can influence several surgical interventions and endovascular procedures. Accidental ligation of the azygos vein is fatal and cardiac catheterization using the lower extremity vein is troublesome in patients with this condition.

A rare variation of the hemiazygos vein draining into the persistent left superior vena cava.

During an educational dissection of a 72-year-old Chinese male cadaver, the hemiazygos vein (HAV) coursing the left side that drains into the persistent left superior vena cava was observed. The HAV was formed at the junction of the 9th to 11th right posterior intercostal veins, right subcostal vein, 5th to 11th left posterior intercostal veins, and left subcostal vein; it then ascended posteriorly to the thoracic aorta. After collecting the accessory hemiazygos vein, it crossed over the aorta and the pedicle of the left lung via the hemiazygos arch, then converged with a communicative branch (vein of Marshall) that emerged from the left brachiocephalic vein to form the persistent left superior vena cava and entered the pericardium at the level of the sixth thoracic vertebra. Upon opening the pericardium of our cadaver, the persistent left superior vena cava was found to drain directly into the significantly dilated coronary sinus at the level of the eighth thoracic vertebra. The azygos vein was formed by the union of the first to eighth right posterior intercostal veins and appeared to be finer and shorter than the HAV. The persistent left superior vena cava might be the result of incomplete degeneration of the left posterior cardinal vein. Knowledge of such variations could be of great value to surgeons placing peripherally inserted central catheters because incorrect placement of the azygos venous system can be detrimental to the patient. In addition, during heart surgery, awareness of such variations may prevent major complications, such as hemorrhage or damage to vascular structures, and possibly also provide new insights and perspectives to cardiovascular surgeries.

There are more anatomical variants in heaven and earth, Horatio, than are dreamt of in our philosophy: the precaval left renal artery.

AIM: To describe the CT findings in eight patients with left-sided inferior vena cava (IVC) in whom the left renal artery presented a precaval course (pLRA). MATERIALS AND METHODS: We searched the teaching files of six radiology departments for patients with pLRAs. Eight patients were found, and the available imaging studies and clinical histories were reviewed. Associated vascular and renal anomalies were noted. RESULTS: No patient had been examined for problems related to the vascular anomaly found. Four had a double IVC and two a solitary left IVC; in all, the left-sided IVCs had hemiazygos continuation. One patient had situs viscerum inversus. In one case, there was a left kidney in left iliac fossa. CONCLUSION: Although rare and probably overlooked, a pLRAs can be encountered in patients with situs viscerum inversus or presenting a left-sided IVC with hemiazygos continuation. These vessels can cause technical problems during surgery at the left renal hilum and should be specifically searched for in patients with vascular anomalies.

Anatomical study of the atypical azygos venous system and its clinical significance / 局解手术学杂志

Objective To investigate the morphology and classification of the atypical azygos venous system,and to provide reference for diagnosis and treatment of mediastinal and thoracic vascular diseases.Methods Thirty cadavers were perfused with 10%formalin solution, and immersed in the solution for one month before dissection.The vertebral levels of termination and diameters of the azygos,hemiazygos and accessory hemiazygos veins were examined.Results There were 24 cases of classical azygos venous system,which contained the azygos, hemiazygos and accessory hemiazygos veins.And there were 6 cases of atypical azygos venous system,which were further divided into 4 sub-groups.Namely,type a(2 cases)which showed an inverted"Y"shape;type b(2 cases)which was single column with hemiazygos and ac-cessory hemiazygos veins absent;type c(1 case)which showed an accessory hemiazygos vein draining into the left brachiocephalic vein;and type d(1 case)with azygos vein and double superior vena cava variation.Diameters of termination of the azygos,hemiazygos and accessory hemiazygos veins were(10.39 ±1.98)mm,(8.51 ±2.28)mm,and(6.29 ±1.56)mm,respectively.The vertebral levels of termination of the azygos,hemiazygos and accessory hemiazygos veins were T 4(83.3%),T7to T10,T4to T8respectively.Conclusion All morphometrical diameters and their termination levels can be used during preoperative CT evaluations before planning invasive mediastinal procedures.The re-sults of this study could be helpful in mediastinal surgery,mediastinoscopy and the surgery of the deformations of the vertebral column in the thoracic cavity.

Variante de las venas hemiácigos: ¿vena ácigos izquierda? reporte de un caso / Variant of the hemiazygos veins: left azygos vein? a case report

INTRODUCCIÓN: El sistema venoso ácigos-hemiácigos es imprescindible en el drenaje del tórax. Estos vasos se originan en la etapa embrionaria a partir de las venas supracardinales, con una serie de afluentes que parten de la pared torácica y mediastino principalmente, encontrando variedades, como nuestro hallazgo, mismos que deben ser considerados en la práctica médica. PRESENTACIÓN DEL CASO: Se presenta un caso encontrado en una disección de pieza cadavérica, de sexo masculino, en el cual se halló un tronco venoso paralelo al lado izquierdo de la columna, que resultaría de la unión de las venas hemiácigos; originándose por la confluencia de la vena subcostal y lumbar ascendente, drenando en la vena braquiocefálica del mismo lado, muy parecido a la vena ácigos, sin conexión entre ambas. DISCUSIÓN: Son muchas las variedades reportadas en diversos estudios, encontrando una clasificación de dichas anomalías en tres tipos, correspondiendo nuestro caso a la variedad tipo I, con una incidencia del 1%; dichas alteraciones pueden originarse en etapa embrionaria por la falta de diferenciación de las venas supracardinales. De esta manera, resaltamos la importancia de estas variantes en el ámbito clínico, quirúrgico e imagenológico. CONCLUSIÓN: El presente hallazgo resulta ser un caso muy particular, a diferencia de otros estudios revisados, por lo que sería pertinente ampliar el trabajo para obtener la incidencia del mismo

INTRODUCTION: The azygos-hemiazygos venous system is necessary in the drainage of the thorax. These vessels originate in the embryological phase from the supracardinal veins, with a series of tributaries that begin in the thoracic Wall and mediastinum mainly, finding varieties, such as our finding, which must be considered in medical practice. CASE PRESENTATION: In a male corpse dissection we found a venous trunk parallel to the left side of the vertebral column which would result in the joining of the hemiazygos veins; beginning in the confluence of the subcostal vein and ascending lumbar, draining in the brachiocephalic vein on the same side, similar to the azygos vein, without any connection between them. DISCUSSION: There are many varieties reported in diverse studies, which can be categorized in three types. Ours corresponds to type I, with an incidence of 1%. Such varieties can originate in embryological phase due to the lack of differentiation of supracardinal veins. We can highlight the importance of such varieties in the clinical and surgical fields. CONCLUSION: Our finding is a very particular case, unlike other revised studies, which is why it would be pertinent to further research this topic

Coronary sinus aneurysm associated with multiple venous anomalies.

BACKGROUND: Congenital anomalies of the venous system are rare, involve the inferior vena cava (IVC), a persistent left superior vena cava (PLSVC), and the left hepatic vein (LHV), and can make cardiac diagnostic and therapeutic procedures difficult. CASE PRESENTATION: We present a 67-year-old woman without heterotaxy syndrome associated with interruption of the left IVC that continued with the hemiazygos vein system, a PLSVC, and an anomalous LHV draining the into coronary sinus (CS). The venous anomalies caused a CS aneurysm. The anomalies were demonstrated by echocardiography and the diagnosis was established by contrast-enhanced computed tomography. Three days later, a coronary artery bypass graft was performed, which confirmed the diagnosis. Half a month after surgery, the pain had been relieved and the patient was discharged from the hospital. CONCLUSION: Echocardiography is a useful modality to diagnose and assess anomalies of the CS, including CS aneurysms. Congenital anomalies of the venous system in this case were all due to embryonic development abnormalities. Contrast-enhanced computed tomography provides a more comprehensive view of the entire course of abnormal veins.