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Combined anomaly of the right hepatic lobe agenesis and absence of the inferior vena cava: a case report.

Suh HJ, Kim WT, Kim MY, Cho YK - Korean J Radiol (2008)

Bottom Line: The absence of the inferior vena cava is an uncommon congenital anomaly that has recently been identified as an important risk factor contributing to the development of deep venous thrombosis.Congenital agenesis of the right hepatic lobe is a rare anomaly which is found incidentally in radiologic examinations.We present a case of a congenital absence of the infrarenal inferior vena cava, combined with agenesis of the right hepatic lobe in a 62-year-old man presented with symptoms of deep venous thrombosis.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Seoul Veterans Hospital, Seoul, Korea.

ABSTRACT
The absence of the inferior vena cava is an uncommon congenital anomaly that has recently been identified as an important risk factor contributing to the development of deep venous thrombosis. Congenital agenesis of the right hepatic lobe is a rare anomaly which is found incidentally in radiologic examinations. We present a case of a congenital absence of the infrarenal inferior vena cava, combined with agenesis of the right hepatic lobe in a 62-year-old man presented with symptoms of deep venous thrombosis.

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Related in: MedlinePlus

62-years-old patient with right hepatic lobe agenesis, combined with deep venous thrombosis caused by congenital absence of inferior vena cava.A. Coronal thick (30 mm) slab maximum intensity projection CT image showed thrombus (arrowheads) occupying entire lumen of right femoral and external iliac vein. Left hepatic vein (arrow) drains into inferior vena cava (asterisk).B. Transverse CT scan obtained inferior to kidney shows missing IVC. Enlarged left testicular vein (arrow) and prominent anterior abdominal wall collateral veins (arrowheads) are present.C. Transverse contrast-enhanced CT scan obtained at hilus level of left kidney shows missing infrarenal segment belonging to IVC. Enlarged ascending lumbar vein and prominent left testicular vein (arrow) are present. Right hepatic lobe is absent and gallbladder (curved arrow) is identified in retrohepatic position.D. Transverse thick (30 mm) slab maximum intensity projection CT image of arterial phase shows left hepatic artery (large arrow) arising from celiac axis. Complete absence of right hepatic artery branch is noted, along with left portal vein (small arrows).E. Coronal MIP of two-dimensional time-of-flight MR image shows absence of infrarenal IVC, with enlarged azygos (large arrow) and hemiazygos vein (small arrows). Tortuous and enlarged left testicular vein (arrowheads) is also noted.
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Figure 1: 62-years-old patient with right hepatic lobe agenesis, combined with deep venous thrombosis caused by congenital absence of inferior vena cava.A. Coronal thick (30 mm) slab maximum intensity projection CT image showed thrombus (arrowheads) occupying entire lumen of right femoral and external iliac vein. Left hepatic vein (arrow) drains into inferior vena cava (asterisk).B. Transverse CT scan obtained inferior to kidney shows missing IVC. Enlarged left testicular vein (arrow) and prominent anterior abdominal wall collateral veins (arrowheads) are present.C. Transverse contrast-enhanced CT scan obtained at hilus level of left kidney shows missing infrarenal segment belonging to IVC. Enlarged ascending lumbar vein and prominent left testicular vein (arrow) are present. Right hepatic lobe is absent and gallbladder (curved arrow) is identified in retrohepatic position.D. Transverse thick (30 mm) slab maximum intensity projection CT image of arterial phase shows left hepatic artery (large arrow) arising from celiac axis. Complete absence of right hepatic artery branch is noted, along with left portal vein (small arrows).E. Coronal MIP of two-dimensional time-of-flight MR image shows absence of infrarenal IVC, with enlarged azygos (large arrow) and hemiazygos vein (small arrows). Tortuous and enlarged left testicular vein (arrowheads) is also noted.

Mentions: A 62-year-old man was admitted to our hospital with advanced stages of swelling in the right lower extremity. The patient had been treated at another hospital for DVT of the lower extremity seventeen years earlier. The patient had no apparent risk factors for any thromboembolic diseases, including recent trauma, surgery, immobilization or familial history of thromboembolism. A physical examination revealed the patient's edematous swelling and redness in the right lower extremity. The patient's peripheral arterial pulses were normal. A color Doppler ultrasonography (US) revealed the complete thrombosis of the right external iliac and femoral vein. We performed a contrast enhanced abdomino-pelvic CT and CT angiography using a multi-detector row CT (Somatom Sensation 64, Siemens, Forchheim, Germany) to define the extent of the disease, which revealed the low density thrombosis of the right femoral and external iliac vein (Fig. 1A), as well as the nonexistent infrarenal segment of the IVC and the common iliac veins (Fig. 1B). The suprarenal IVC originates from the confluence of the renal veins. In the study patient, the hepatic vein was connected to the infrahepatic segment of the IVC and the IVC drained normally into the right atrium. Furthermore, a prominent azygos vein, hemiazygos vein, paravertebral venous plexus, lumbar vein, and left testicular vein were seen. The left renal vein was connected to the left testicular vein and also drained into the dilated lumbar vein (Fig. 1C). The bilateral, external, and internal iliac veins were drained to enlarge the azygos and hemiazygos veins via the ascending lumbar vein and anterior paravertebral venous plexus.


Combined anomaly of the right hepatic lobe agenesis and absence of the inferior vena cava: a case report.

Suh HJ, Kim WT, Kim MY, Cho YK - Korean J Radiol (2008)

62-years-old patient with right hepatic lobe agenesis, combined with deep venous thrombosis caused by congenital absence of inferior vena cava.A. Coronal thick (30 mm) slab maximum intensity projection CT image showed thrombus (arrowheads) occupying entire lumen of right femoral and external iliac vein. Left hepatic vein (arrow) drains into inferior vena cava (asterisk).B. Transverse CT scan obtained inferior to kidney shows missing IVC. Enlarged left testicular vein (arrow) and prominent anterior abdominal wall collateral veins (arrowheads) are present.C. Transverse contrast-enhanced CT scan obtained at hilus level of left kidney shows missing infrarenal segment belonging to IVC. Enlarged ascending lumbar vein and prominent left testicular vein (arrow) are present. Right hepatic lobe is absent and gallbladder (curved arrow) is identified in retrohepatic position.D. Transverse thick (30 mm) slab maximum intensity projection CT image of arterial phase shows left hepatic artery (large arrow) arising from celiac axis. Complete absence of right hepatic artery branch is noted, along with left portal vein (small arrows).E. Coronal MIP of two-dimensional time-of-flight MR image shows absence of infrarenal IVC, with enlarged azygos (large arrow) and hemiazygos vein (small arrows). Tortuous and enlarged left testicular vein (arrowheads) is also noted.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2627190&req=5

Figure 1: 62-years-old patient with right hepatic lobe agenesis, combined with deep venous thrombosis caused by congenital absence of inferior vena cava.A. Coronal thick (30 mm) slab maximum intensity projection CT image showed thrombus (arrowheads) occupying entire lumen of right femoral and external iliac vein. Left hepatic vein (arrow) drains into inferior vena cava (asterisk).B. Transverse CT scan obtained inferior to kidney shows missing IVC. Enlarged left testicular vein (arrow) and prominent anterior abdominal wall collateral veins (arrowheads) are present.C. Transverse contrast-enhanced CT scan obtained at hilus level of left kidney shows missing infrarenal segment belonging to IVC. Enlarged ascending lumbar vein and prominent left testicular vein (arrow) are present. Right hepatic lobe is absent and gallbladder (curved arrow) is identified in retrohepatic position.D. Transverse thick (30 mm) slab maximum intensity projection CT image of arterial phase shows left hepatic artery (large arrow) arising from celiac axis. Complete absence of right hepatic artery branch is noted, along with left portal vein (small arrows).E. Coronal MIP of two-dimensional time-of-flight MR image shows absence of infrarenal IVC, with enlarged azygos (large arrow) and hemiazygos vein (small arrows). Tortuous and enlarged left testicular vein (arrowheads) is also noted.
Mentions: A 62-year-old man was admitted to our hospital with advanced stages of swelling in the right lower extremity. The patient had been treated at another hospital for DVT of the lower extremity seventeen years earlier. The patient had no apparent risk factors for any thromboembolic diseases, including recent trauma, surgery, immobilization or familial history of thromboembolism. A physical examination revealed the patient's edematous swelling and redness in the right lower extremity. The patient's peripheral arterial pulses were normal. A color Doppler ultrasonography (US) revealed the complete thrombosis of the right external iliac and femoral vein. We performed a contrast enhanced abdomino-pelvic CT and CT angiography using a multi-detector row CT (Somatom Sensation 64, Siemens, Forchheim, Germany) to define the extent of the disease, which revealed the low density thrombosis of the right femoral and external iliac vein (Fig. 1A), as well as the nonexistent infrarenal segment of the IVC and the common iliac veins (Fig. 1B). The suprarenal IVC originates from the confluence of the renal veins. In the study patient, the hepatic vein was connected to the infrahepatic segment of the IVC and the IVC drained normally into the right atrium. Furthermore, a prominent azygos vein, hemiazygos vein, paravertebral venous plexus, lumbar vein, and left testicular vein were seen. The left renal vein was connected to the left testicular vein and also drained into the dilated lumbar vein (Fig. 1C). The bilateral, external, and internal iliac veins were drained to enlarge the azygos and hemiazygos veins via the ascending lumbar vein and anterior paravertebral venous plexus.

Bottom Line: The absence of the inferior vena cava is an uncommon congenital anomaly that has recently been identified as an important risk factor contributing to the development of deep venous thrombosis.Congenital agenesis of the right hepatic lobe is a rare anomaly which is found incidentally in radiologic examinations.We present a case of a congenital absence of the infrarenal inferior vena cava, combined with agenesis of the right hepatic lobe in a 62-year-old man presented with symptoms of deep venous thrombosis.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Seoul Veterans Hospital, Seoul, Korea.

ABSTRACT
The absence of the inferior vena cava is an uncommon congenital anomaly that has recently been identified as an important risk factor contributing to the development of deep venous thrombosis. Congenital agenesis of the right hepatic lobe is a rare anomaly which is found incidentally in radiologic examinations. We present a case of a congenital absence of the infrarenal inferior vena cava, combined with agenesis of the right hepatic lobe in a 62-year-old man presented with symptoms of deep venous thrombosis.

Show MeSH
Related in: MedlinePlus