RESUMEN
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.
Asunto(s)
Riñón Único , Vena Cava Inferior , Abdomen , Adulto , Anomalías Congénitas , Drenaje , Atrios Cardíacos/diagnóstico por imagen , Atrios Cardíacos/cirugía , Humanos , Riñón/anomalías , Enfermedades Renales/congénito , Masculino , Resultado del Tratamiento , Vena Cava Inferior/anomalías , Vena Cava Inferior/diagnóstico por imagen , Vena Cava Superior/diagnóstico por imagenRESUMEN
BACKGROUND: Dual-energy computed tomography (DECT) utilises the technique of simultaneous image acquisition of a body part at two different energy levels of the X-ray tubes. We used the DECT in this project to study its accuracy in non-invasive in vivo differentiation of uric acid (UA) calculi from non-UA calculi using the 3rd generation dual-source computed tomography (CT) scanner. MATERIALS AND METHODS: The DECT ratios of the various stones were noted and compared with the postextraction analysis of stones for composition. Sixty stones from 53 patients were included in the study, and their DECT results were compared with the post-extraction analysis (by infrared spectroscopy as the standard comparative method). RESULTS: DECT was highly sensitive and specific in the diagnosis of various types of calculi based on their dual-energy ratio. It was found to be 100% sensitive and specific for differentiating UA stones from the non-UA stones. The DE ratio for the UA stones was found to be 0.98-1.13. Most of the stones belonged to non-UA category (85%), and only 15% were UA calculi. The sensitivity and specificity in differentiating a calcium oxalate from non-calcium oxalate calculus was 97.8% and 92.3%, respectively. CONCLUSION: DECT using the 3rd generation CT scanners is highly sensitive in the determination of urinary calculi composition which will be very helpful to the treating surgeon in selecting the optimal modality of treatment as UA stones are amenable to medical therapy while most of the non-UA stones require surgical intervention.