RESUMEN
The presentation and investigation of a levopositioned caudal vena cava, a rare congenital vascular abnormality seen mainly in Bernese Mountain Dogs, which resulted in ureteral compression, hydronephrosis and hydroureter. Surgical transection, transposition and anastomosis were performed to reposition the circumcaval ureter. A 19-month-old male neutered Bernese Mountain Dog was presented with a 13-month history of vague signs including intermittent abdominal pain, inappetence and diarrhoea, which were poorly responsive to medical management. Abdominal ultrasound revealed left-sided hydronephrosis and hydroureter. Further investigation included abdominal computed tomography and pre- and post-intravenous iodinated contrast, which revealed a levopositioned caudal vena cava with associated ureteral displacement to a circumcaval position, resulting in ureteral compression and proximal dilation affecting both the proximal ureter and the left kidney. The patient was also found to have concomitant gall bladder agenesis. Surgery was performed to transect, transpose and anastomose the ureter in a normal anatomical position, and the patient made an excellent clinical recovery. All gastrointestinal signs resolved within 2 weeks of surgery and remained resolved 12 months later. Follow-up ultrasound and pyelography were performed at 4-month post-surgery, revealing a mild improvement in the hydronephrosis and hydroureter. Although rare, circumcaval ureter should be considered a differential in dogs presenting with hydroureter and hydronephrosis, especially Bernese Mountain Dogs.
Asunto(s)
Enfermedades de los Perros , Hidronefrosis , Uréter , Vena Cava Inferior , Animales , Perros , Masculino , Hidronefrosis/veterinaria , Hidronefrosis/cirugía , Hidronefrosis/etiología , Enfermedades de los Perros/cirugía , Enfermedades de los Perros/diagnóstico por imagen , Vena Cava Inferior/anomalías , Vena Cava Inferior/cirugía , Uréter/anomalías , Uréter/cirugía , Enfermedades Ureterales/veterinaria , Enfermedades Ureterales/cirugía , Enfermedades Ureterales/congénitoRESUMEN
Here, we describe an interesting case of a patient with the duplication of inferior vena cava, high-positioned bifurcation of the abdominal aorta with transposition of iliac arteries, and right renal aplasia associated with end-stage renal disease who underwent kidney transplant. In this case, the patient with anorectal malformations with a vaginal fistula was prepared and underwent a kidney transplant. During the surgery, we discovered duplicated inferior vena cava and transposed iliac arteries. After the surgery, computed tomography angiography revealed the inferior vena cava duplication with the 2 connections between the right and left inferior vena cava with the formation of an anomalous circle, high-positioned bifurcation of the abdominal aorta at the level of the L2 vertebral body, and transposition of right and left iliac arteries. Also, we observed the right kidney aplasia and absence of blood circulation in the left native kidney. In our case, a delayed diagnosis of pyelonephritis resulted in the progression to end-stage renal disease that necessitated a kidney transplant, during which we found these anomalies. We confirmed the asymptomatic course of these anomalies, diagnosed only during radiological imaging or surgical intervention. Patients with congenital anomalies of the kidney and urinary tract should undergo complete investigations before surgical decisions. Diagnosis of this pathology in the preoperative period, especially in transplant patients, will alert the surgery team in advance of the operation and allow preparation for the intraoperative difficulties that are typically associated with anomalies such as inferior vena cava transposition or aplasia.
Asunto(s)
Aorta Abdominal , Fallo Renal Crónico , Trasplante de Riñón , Malformaciones Vasculares , Vena Cava Inferior , Humanos , Vena Cava Inferior/anomalías , Vena Cava Inferior/diagnóstico por imagen , Vena Cava Inferior/cirugía , Femenino , Fallo Renal Crónico/cirugía , Fallo Renal Crónico/etiología , Fallo Renal Crónico/diagnóstico , Resultado del Tratamiento , Aorta Abdominal/anomalías , Aorta Abdominal/cirugía , Aorta Abdominal/diagnóstico por imagen , Malformaciones Vasculares/cirugía , Malformaciones Vasculares/complicaciones , Malformaciones Vasculares/diagnóstico por imagen , Aortografía , Angiografía por Tomografía Computarizada , Anomalías Múltiples/cirugía , Flebografía/métodos , Hallazgos Incidentales , Arteria Ilíaca/cirugía , Arteria Ilíaca/anomalías , Arteria Ilíaca/diagnóstico por imagen , Adulto , Pielonefritis/cirugía , Pielonefritis/etiología , Pielonefritis/diagnóstico , Pielonefritis/diagnóstico por imagen , Valor Predictivo de las PruebasRESUMEN
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
BACKGROUND: Inferior vena cava agenesis (IVCA) is a rare anomaly predisposing affected people to lower-limb venous thrombosis with low frequency of pulmonary embolism. Antenatal thrombosis and inherited thrombophilia have been suggested as causes of IVCA. However, there is little evidence on the clinical course and management of this condition. We designed a patient registry to assess the thrombotic risk and features of IVCA. METHODS: In this this multicentre, retrospective, observational study, we included patients with IVCA diagnosed by routine imaging from 20 hospitals in Spain (n=18), Portugal (n=1), and Italy (n=1). Patients were identified from a systematic search in radiology databases using data extraction software (cohort A) and alternative searches in medical records for confirmed IVCA (cohort B; option allowed when systematic approaches were unapplicable). Primary outcomes were clinical and imaging features, thrombotic risk, phenotype of IVCA-associated thrombosis, anticoagulant treatment, and the results of thrombophilia testing. FINDINGS: We included patients with IVCA diagnosed by routine imaging studies done between Jan 1, 2010, and Dec 31, 2022. In the systematic search, 4 341 333 imaging exams were screened from the radiology databases of eight centres. 122 eligible patients were enrolled in cohort A. A further 95 patients were identified by screening medical records at 12 centres, of whom 88 were eligible and included in cohort B, making a combined cohort of 210 patients. 96 (46%) of 210 patients were female and 200 (95%) were European or Hispanic. 60 (29%) of 210 patients had hepatic IVC interruption, whereas 150 (71%) had extrahepatic IVCA. In cohort A, 65 (53%) of 122 patients had venous thrombosis, with an estimated annual risk of 1·15% (95% CI 0·89-1·46). Extrahepatic IVCA was associated with a greater risk of venous thrombosis than hepatic IVCA (56 [67%] of 84 patients vs nine [24%] of 38 patients, odds ratio 5·31, 95% CI 2·27-12·43; p<0·0001). Analysis of 126 patients with venous thrombosis pooled from cohorts A and B showed early-onset (median age 34·6 years, IQR 23·3-54·3) and recurrent events (50 [40%] of 126 patients). Patients with extrahepatic IVCA had greater proportions of lower-limb venous thrombosis (95 [87%] of 109 vs nine [53%] of 17, p=0·0010) and recurrence (48 [44%] of 109 vs two [12%] of 17, p=0·015), but lower rates of pulmonary embolism (10 [10%] of 99 vs four [33%] of 12, p=0·044) than did patients with hepatic IVCA. 77 (63%) of 122 patients with thrombosis underwent indefinite anticoagulation. 32 (29%) of 111 patients (29 [34%] of 86 with thrombosis) had coexisting thrombophilias. The recurrence risk was lower for patients receiving indefinite anticoagulation (adjusted odds ratio 0·24, 95% CI 0·08-0·61; p=0·010), and greater for thrombophilias (3·19, 1·09-9·32; p=0·034). INTERPRETATION: This evaluation of a large patient cohort demonstrates the high thrombotic burden of IVCA. We have identified two distinct forms of IVCA, hepatic and extrahepatic, suggesting different underlying mechanisms. Beyond clinical characterisation, we draw attention to this orphan disease and highlight the need for its study and improved care. FUNDING: Spanish Society of Thrombosis and Haemostasis, Instituto de Salud Carlos III, FEDER, Fundación Séneca.
Asunto(s)
Vena Cava Inferior , Trombosis de la Vena , Humanos , Vena Cava Inferior/anomalías , Vena Cava Inferior/diagnóstico por imagen , Vena Cava Inferior/patología , Estudios Retrospectivos , Femenino , Masculino , Adulto , Persona de Mediana Edad , Factores de Riesgo , Trombosis de la Vena/etiología , Trombosis de la Vena/epidemiología , Anticoagulantes/uso terapéutico , Trombofilia/complicaciones , Adulto Joven , AdolescenteRESUMEN
Agenesis of inferior vena cava (AIVC) is an extremely rare congenital abnormality. In AIVC, venous flow from the lower extremities enter superior vena cava mainly through the azygous and hemiazygous system, forming anastomotic collateral vessels. A global increase in intra-abdominal pressure by the gravid uterus may further stress the collateral system, increase venous stasis and decrease venous return. We present the management of a 37-year old pregnant woman with AIVC who underwent caesarean section with norepinephrine infusion and general anaesthesia. She presented with shortness of breath when seated, episodes of dizziness while walking or sitting upright with subsequent tachycardia. Cardiac status was monitored using an arterial pulse contour CO monitor. We did not observe large fluctuations in CO, SV, MAP during induction and intubation as well as during delivery. We believe that administration of an infusion of norepinephrine from induction to anaesthesia through caesarean section contributed to this result. Sympathetic activation caused venoconstriction, which significantly increased venous return and maintained haemodynamic stability.
Asunto(s)
Cesárea , Vena Cava Inferior , Humanos , Femenino , Embarazo , Vena Cava Inferior/anomalías , Adulto , Complicaciones Cardiovasculares del Embarazo , Norepinefrina/administración & dosificación , Norepinefrina/uso terapéuticoRESUMEN
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 , FemeninoRESUMEN
Inferior vena cava (IVC) anomalies are uncommon congenital causes of deep vein thrombosis (DVT). KILT syndrome (kidney and IVC abnormalities with leg thrombosis) has only been described as case reports in the literature. Therefore, the characteristics, evaluation, and management of patients with KILT syndrome have not yet been standardized. This study aimed to systematically review and analyze the clinical and radiographic data and treatment of previously reported cases of KILT syndrome. In this systematic review, we performed a literature search of the PubMed, Scopus, and Web of Science databases in December 2023, with no restrictions on the publication date. After duplicate extractions, 4195 articles were screened. Case reports and case series reporting on KILT syndrome were included. In addition to previously published cases, we included a new case of a previously healthy 25-year-old man with KILT syndrome in the analysis. A total of 34 cases were therefore included in this study. The majority (76.5%) were male patients with a median age of 24 years. In most patients, unprovoked bilateral iliofemoral thrombosis was diagnosed, and 64.7% had left kidney abnormalities. Our study suggests that anomalies of the IVC should be suspected in all young patients, especially male patients, with proximal, recurrent, or idiopathic DVT. If an IVC anomaly is confirmed, the kidneys should be examined to monitor and preserve healthy kidneys in cases of KILT syndrome. The data collected from all patients emphasize the requirement of long-term anticoagulation and risk factor control. Surgical measures may be effective for treating symptomatic refractory cases.
Asunto(s)
Riñón , Vena Cava Inferior , Trombosis de la Vena , Humanos , Vena Cava Inferior/anomalías , Vena Cava Inferior/diagnóstico por imagen , Trombosis de la Vena/diagnóstico por imagen , Trombosis de la Vena/etiología , Trombosis de la Vena/terapia , Riñón/anomalías , Riñón/irrigación sanguínea , Masculino , Adulto , Femenino , Adulto Joven , Factores de Riesgo , Adolescente , Niño , Resultado del Tratamiento , Malformaciones Vasculares/complicaciones , Malformaciones Vasculares/diagnóstico por imagen , Anticoagulantes/uso terapéutico , Preescolar , Persona de Mediana EdadAsunto(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 , FemeninoRESUMEN
OBJECTIVE: Intraluminal anomalies within the left common iliac vein, characteristic of iliac vein compression syndrome, are thought to result from compression by and pulsation of the overlying right common iliac artery. This cadaver study was designed to expand on the existing literature by surveying and photographing these spurs in addition to exploring whether certain factors, inherent to the cadaver, are associated with spur presence. METHODS: Dissection to expose the aorta, inferior vena cava, and common iliac arteries and veins was performed in 51 cadavers. The spinal level at which the iliac vein confluence occurred was noted. The point at which the right common iliac artery crossed the left common iliac vein was examined for plaque presence. The overlying arterial structures were then transected to expose the venous system. The inferior vena cava was incised to facilitate observation into the mouth and full extent of the left common iliac vein. Spurs were photographed and documented. Statistical analysis was conducted to determine whether sex, body mass index (BMI), plaque presence, or level of the iliac vein confluence are associated with spur presence. RESULTS: Spurs within the left common iliac vein were observed in 16 of 51 cadavers (31.4%). All spurs were located at the point that the right common iliac artery crossed the left common iliac vein. Using1 the classification system established by McMurrich, 67% of spurs (n = 10) were marginal and triangular; 25% (n = 4) were columnar. One marginal, linear spur (6%) and one partially obstructed spur with multiple synechiae (6%) were observed. Among this population, males were 73% less likely to have a spur (odds ratio, 0.269; P = .041). No significant relationship was found between plaque presence and spur presence (odds ratio, 0.933; P = .824) and no significant differences were noted between BMI and spur presence (χ2 = 1.752, P = .625). Last, a significantly greater percent of spurs was found within cadavers with an iliac vein confluence located at the L5/S1 disc space (χ2 = 9.650; P = .002). CONCLUSIONS: Study findings show that spurs are more common when the confluence of the common iliac veins occurs at a lower spinal level. The level of the iliac vein confluence may be important in identifying patients at increased risk of venous disease. The findings also suggest that plaque within the right common iliac artery and BMI display no distinct relationship with spur presence. Further investigation is needed to understand exactly what factors lead to spur formation.
Asunto(s)
Vena Ilíaca , Vena Cava Inferior , Masculino , Humanos , Vena Cava Inferior/anomalías , Vena Ilíaca/anomalías , Aorta Abdominal , Arterias , CadáverRESUMEN
The inferior vena cava (IVC) and superior vena cava are the main conduits of the systemic venous circulation into the right atrium. Developmental or procedural interruptions of vena cava might predispose to stasis and deep vein thrombosis (DVT) distal to the anomaly and may impact the subsequent rate of pulmonary embolism (PE). This study aimed to review the various etiologies of developmental or procedural vena cava interruption and their impact on venous thromboembolism. A systematic search was performed in PubMed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines per each clinical question. For management questions with no high-quality evidence and no mutual agreements between authors, Delphi methods were used. IVC agenesis is the most common form of congenital vena cava interruption, is associated with an increased risk of DVT, and should be suspected in young patients with unexpected extensive bilateral DVT. Surgical techniques for vena cava interruption (ligation, clipping, and plication) to prevent PE have been largely abandoned due to short-term procedural risks and long-term complications, although survivors of prior procedures are occasionally encountered. Vena cava filters are now the most commonly used method of procedural interruption, frequently placed in the infrarenal IVC. The most agreed-upon indication for vena cava filters is for patients with acute venous thromboembolism and coexisting contraindications to anticoagulation. Familiarity with different forms of vena cava interruption and their local and systemic adverse effects is important to minimize complications and thrombotic events.
Asunto(s)
Tromboembolia Venosa , Humanos , Tromboembolia Venosa/etiología , Vena Cava Inferior/anomalíasRESUMEN
Scimitar syndrome (SS) is a rare entity with an incidence of approximately 1-3 in 200 000 people. It is typically characterized by complete or partial anomalous pulmonary venous drainage from the right lung into the systemic venous circulation, most commonly the inferior vena cava (IVC). For the first time, we report the diagnosis of SS in a fetus in utero using four-dimensional (4D) spatiotemporal image correlation combined with high-definition live flow rendering mode (STIC-HD live flow).
Asunto(s)
Venas Pulmonares , Síndrome de Cimitarra , Humanos , Femenino , Embarazo , Síndrome de Cimitarra/diagnóstico por imagen , Venas Pulmonares/anomalías , Pulmón/anomalías , Vena Cava Inferior/diagnóstico por imagen , Vena Cava Inferior/anomalías , Diagnóstico PrenatalRESUMEN
In an adult patient, coronary artery fistula involving the circumflex artery (CX) connected to the coronary sinus caused aneurysm of the left main and CX associated with ectasia of the intermediate branch. The patient had posterolateral infarction with severe ischemic mitral regurgitation and moderate tricuspid regurgitation. A rare venous return anomaly was also present. The inferior vena cava, which was interrupted at the level of the liver, continued with the hemiazygos to drain into a persistent left superior vena cava, which in turn drained into the coronary sinus. Surgery included CX closure and mitral and tricuspid repair. The strategy had to be adapted to the anatomy. The fistula was dissected and snared for cardioplegia delivery, and venous return was achieved by cannulation of the superior vena cava and femoral vein. The procedure was uneventful, and 4 years later the patient is asymptomatic.
Asunto(s)
Seno Coronario , Fístula , Cardiopatías Congénitas , Humanos , Adulto , Seno Coronario/cirugía , Vena Cava Superior/anomalías , Vasos Coronarios/diagnóstico por imagen , Vasos Coronarios/cirugía , Vena Cava Inferior/cirugía , Vena Cava Inferior/anomalíasRESUMEN
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
Deep vein thrombosis (DVT) is common in the general population, with an annual incidence of 1 to 2 per 1000 people. Inferior vena cava agenesis (IVCA) increased the risk of developing DVT and is found in approximately 5% of young adults (20-40-year-olds) diagnosed with unprovoked proximal DVT. IVCA can be caused by a defective embryological process, or be a result of intrauterine or perinatal thrombosis. Its estimated incidence in the general population ranges from 0.0005% to 1%, usually involving a partial absence of one of the four segments of the inferior vena cava (IVC). The management during the extended phase of patients with DVT associated with IVCA is not yet harmonized, as it is poorly described in the literature. Patients with IVCA are considered to be at high risk of DVT occurrence, prompting physicians to continue extended anticoagulation, often using vitamin K antagonists. In this retrospective study, we present a cohort of 11 patients diagnosed with IVCA following a DVT, who subsequently received extended treatment with a direct oral anticoagulants. These findings offer reassuring insights into the extended utilization of direct oral anticoagulants, demonstrating both antithrombotic efficacy and a favorable safety profile.
Asunto(s)
Trombosis , Trombosis de la Vena , Adulto Joven , Humanos , Vena Cava Inferior/anomalías , Trombosis de la Vena/etiología , Estudios Retrospectivos , Anticoagulantes/uso terapéutico , Trombosis/tratamiento farmacológicoRESUMEN
BACKGROUND: Nutcracker syndrome (NCS) caused by left renal vein (LRV) entrapment, is one of the most common causes of orthostatic proteinuria. In stereotype, orthostatic proteinuria is often accompanied by left renal vein obstruction and is found in young and underweight individuals. Here, we report a rare case with orthostatic proteinuria in an old obese female caused by a rare type of congenital inferior vena cava (IVC) interruption. CASE PRESENTATION: A 65-year-old obese woman, who suffered from fluctuated proteinuria, had been misdiagnosed as chronic glomerulitis for 30 years. Instead of having any sign of NCS, she had a unique type of IVC interruption. Most venous blood from infrarenal IVC and right kidney drained into her LRV, and then through the expanded communicating vessel, drained into the left ascending lumbar vein which extended as hemiazygos vein. To the best of our knowledge, this is one of the first cases reported of orthostatic proteinuria attributed to the subsequent hemodynamic irregularity caused by IVC interruption without nutcracker phenomenon. CONCLUSION: Adult-onset orthostatic proteinuria is relatively rare, hard to be recognized and could be misdiagnosed as chronic glomerulonephritis. The case provided a novel differential diagnostic condition for those who suffered from fluctuated proteinuria of unknown causes.
Asunto(s)
Venas Renales , Vena Cava Inferior , Humanos , Adulto , Femenino , Anciano , Vena Cava Inferior/diagnóstico por imagen , Vena Cava Inferior/anomalías , Venas Renales/anomalías , Riñón , Proteinuria/etiologíaRESUMEN
Features of treatment of venous thromboembolism in patients with abnormalities in the development of the inferior vena cava. Congenital anomalies of IVC development are a rather rare pathology. The analysis of treatment results will better understand the pathophysiology of the disease and form an optimal treatment strategy. We analyzed the results of treatment of 1243 patients with venous thromboembolism from 2010 to 2022. Congenital anomalies of inferior vena cava(IVC) development were diagnosed in 2 (0.16%) patients. One patient had IVC aplasia, the other had IVC hypoplasia. Both patients had bilateral iliofemoral deep vein thrombosis(DVT). For the treatment of patients, we used anticoagulant therapy and elastic compression of the lower extremities. During the study period, venous thromboembolic complications in the form of pulmonary embolism were not recorded, fatal complications were not diagnosed. Thus, the results of treatment of patients with venous thromboembolism and anomalies in the development of IVC suggest that the use of anticoagulant therapy in this category of patients allows to obtain positive results of treatment.
Asunto(s)
Embolia Pulmonar , Tromboembolia Venosa , Trombosis de la Vena , Humanos , Tromboembolia Venosa/complicaciones , Tromboembolia Venosa/tratamiento farmacológico , Vena Cava Inferior/diagnóstico por imagen , Vena Cava Inferior/anomalías , Trombosis de la Vena/complicaciones , Trombosis de la Vena/tratamiento farmacológico , Anticoagulantes/uso terapéuticoRESUMEN
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.
Asunto(s)
Síndrome de Heterotaxia , Vena Cava Superior Izquierda Persistente , Malformaciones Vasculares , Recién Nacido , Femenino , Humanos , Vena Cava Inferior/diagnóstico por imagen , Vena Cava Inferior/anomalías , Vena Cava Superior/diagnóstico por imagen , Vena Cava Superior/anomalías , Atrios Cardíacos/diagnóstico por imagen , Malformaciones Vasculares/complicaciones , Malformaciones Vasculares/diagnóstico por imagen , DrenajeRESUMEN
BACKGROUND: Agenesis of the inferior vena cava (IVC) is an extremely rare congenital malformation. Although IVC dysplasia can present with symptoms, because of the low prevalence of this disease, it is often omitted from routine examination. Most reports on this topic have described the absence of the IVC; the absence of both a deep venous system and the IVC is even rarer. Chronic venous hypertension and varicosities leading to venous ulcers have been reported in patients with absent IVC that could be surgically bypassed; however, the absence of iliofemoral veins precluded any bypass procedure in the present patient. CASE PRESENTATION: The authors report a case of IVC below renal vein hypoplasia in a 5-year-old girl who presented bilaterally with venous stasis dermatitis and ulcers in the lower extremity limb area. Ultrasonography revealed no clear IVC and iliofemoral venous system under the renal venous plane. Magnetic resonance venography subsequently confirmed the same findings. The patient's ulcers were healed by compression therapy and routine wound care. CONCLUSIONS: This is a rare case of venous ulcer in a pediatric patient stemming from congenital IVC malformation. With this case, the authors demonstrate the etiology of the appearance of venous ulcers in children.