Congenital Anomalies of the Inferior Vena Cava Revealed on CT in Patients with Deep Vein Thrombosis
G. Gayer1,2,3,
J. Luboshitz2,4,
M. Hertz1,2,
R. Zissin2,5,
M. Thaler2,6,
A. Lubetsky2,4,
A. Bass2,7,
A. Korat1,2 and
S. Apter1,2
1 Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer 52621,
Israel.
2 Sackler School of Medicine, Tel-Aviv University, Tel Aviv 69978, Israel.
3 Present address: Department of Diagnostic Imaging, Assaf Harofeh Medical
Center, Zerifin 70300, Israel.
4 Department of Hematology, Institute of Thrombosis and Hemostasis and the
National Hemophilia Center, Sheba Medical Center, Tel Hashomer 52621,
Israel.
5 Department of Diagnostic Imaging, Sapir Medical Center, Kfar Saba 44281,
Israel.
6 Department of Internal Medicine D, Sheba Medical Center, Tel Hashomer 52621,
Israel.
7 Department of Vascular Surgery, Assaf Harofeh Medical Center, Zerifin 70300,
Israel.
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Fig. 1A. —21-year-old man who presented with painful swelling of left
leg. Lower back pain had started 10 days earlier. Axial contrast-enhanced CT
scan obtained at level of upper poles of kidneys shows cluster of collateral
veins (arrow) anterior to right kidney, whereas suprarenal segment of
inferior vena cava is not seen. Two small accessory spleens are seen adjacent
and medial to posterior edge of spleen.
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Fig. 2A. —25-year-old man presented with painful swelling of right leg
and low-grade fever (37.8°C). Sonography showed bilateral thrombosis of
iliac veins and right femoral vein. CT was performed to rule out malignant
process because chest radiography showed widening of mediastinum, and
sonography raised suspicion of enlarged retroperitoneal lymph nodes. Axial
contrast-enhanced CT scan shows absence of infrarenal segment of inferior vena
cava at level of L3. Prominent ascending lumbar veins (arrowheads)
are seen coursing from pelvis cranially along medial aspect of psoas
muscles.
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Fig. 3A. —57-year-old man with left lower quadrant and left groin pain
as well as high fever (39.2°C), chills, tender left flank, and hematuria.
CT was performed because of clinically suspected intraabdominal abscess. Axial
contrast-enhanced CT scan obtained at level of hilus of left kidney shows
tubular filling defect and thrombus in dilated left renal vein
(arrow), which does not cross anterior to aorta.
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Fig. 3B. —57-year-old man with left lower quadrant and left groin pain
as well as high fever (39.2°C), chills, tender left flank, and hematuria.
CT was performed because of clinically suspected intraabdominal abscess. Axial
contrast-enhanced CT scan obtained 3 cm more caudal than A shows
thrombus in left inferior vena cava (arrow). Normal inferior vena
cava is seen on right.
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Fig. 1C. —21-year-old man who presented with painful swelling of left
leg. Lower back pain had started 10 days earlier. Axial contrast-enhanced CT
scan shows thrombi (arrowheads) in both common iliac veins. Ascending
lumbar veins (solid arrows) and internal paravertebral venous plexus
(open arrow) are prominent.
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Fig. 2B. —25-year-old man presented with painful swelling of right leg
and low-grade fever (37.8°C). Sonography showed bilateral thrombosis of
iliac veins and right femoral vein. CT was performed to rule out malignant
process because chest radiography showed widening of mediastinum, and
sonography raised suspicion of enlarged retroperitoneal lymph nodes. Axial
contrast-enhanced CT scan shows thrombi (arrows) in common iliac
veins bilaterally. Additional thrombi involved right external iliac and right
femoral veins (not shown).
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Fig. 3C. —57-year-old man with left lower quadrant and left groin pain
as well as high fever (39.2°C), chills, tender left flank, and hematuria.
CT was performed because of clinically suspected intraabdominal abscess. Axial
contrast-enhanced CT scan shows thrombus extending along left common iliac
vein (arrowhead) and also involving left external iliac vein and left
femoral vein (not shown). Prominent veins are seen in internal paravertebral
venous plexus (arrow) and in subcutaneous fat of anterior abdominal
wall.
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Fig. 1B. —21-year-old man who presented with painful swelling of left
leg. Lower back pain had started 10 days earlier. Axial contrast-enhanced CT
scan obtained at level of lower poles of kidneys shows thrombus
(arrow) occupying entire lumen of infrarenal inferior vena cava.
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Fig. 1D. —21-year-old man who presented with painful swelling of left
leg. Lower back pain had started 10 days earlier. Axial contrast-enhanced CT
scan obtained at level of lung bases shows prominent azygos vein
(arrowhead) adjacent and to right of descending aorta, with dilated
vein having almost same width as aorta.
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Fig. 4. —46-year-old man who presented with painful swelling of left
leg. He had suffered from lower back pain for several days. Patient had
episode of deep vein thrombosis in his right leg 17 years earlier. Sonogram
showed ileofemoral thrombosis, tiny right kidney, slightly enlarged liver, and
absence of portal vein. Axial contrast-enhanced CT scan obtained at level of
porta hepatis shows portal vein to be absent and shows multiple small veins
representing cavernous transformation of portal vein (arrow).
Intrahepatic segment of inferior vena cava is small, and dilated azygos and
hemiazygos veins (arrowheads) are shown on both sides of aorta in
retrocrural space.
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Copyright © 2003 by the American Roentgen Ray Society.
