Incidental discovery of duplicated inferior vena cava in a s
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A 77-year-old man was referred by the emergency department for an abdominal-pelvic CT scan with clinical information on cytolysis, cholestasis, suspicion of gallstone migration, and search for a pancreatic neoplastic obstruction. On physical examination, the man presented with fluctuating pain in the right hypochondrium for 04 days, without associated fever or biological inflammatory syndrome. The serum lipase level was normal.

His main medical history was prostatic neoplasia operated with radiotherapy afterward for recurrence due to an increase in circulating PSA levels; he was also a peripheral vasculopathy with ischemic heart disease who had undergone iliac and coronary angioplasty. The abdominal ultrasound previously performed showed multiple gallstones without clear signs of cholecystitis. The CT scan was performed on a device with 16 detector rows; the PDL (Product Dose Length) was 1338 mGy.cm. Acquisition of the abdomen in spontaneous contrast, of the liver at arterial phase, and of the abdomen and pelvis at the portal phase of a 90 ml injection of Xenetix 350 were performed successively.

Analysis of the CT scans showed 03 cholesterol-like vesicular gallstones without evidence of gallbladder inflammation, hepatic biliary cysts, nondilated intra- and extra-hepatic bile ducts without the pancreatic mass syndrome, and a small patch of splenic ischemia underneath the inferior polar capsular; the prostatic compartment was empty with multiple surgical clips within the pelvic excavation. Incidentally, a fusion defect of the right and left common iliac veins with a duplication of the inferior vena cava was demonstrated, each common iliac vein draining into the ipsilateral inferior vena cava and the two vena cava running on either side of the aorta.

The left IVC, after receiving the ipsilateral renal vein at L2, continued into a major preaortic trunk (MPAT) that moved obliquely in front of the aorta under the emergence of the superior mesenteric artery. At the level of L1, the MPAT emptied into the right IVC which received at the same level the right renal vein. In total, it was a complete asymmetric duplication of type III IVC according to Natsis because it involved both the renal segment and the infrarenal segment with a left IVC of smaller diameter. The patient received 2 weeks later a laparoscopic clolecystectomy; the surgery was carried out without incident or complications. The IVC anatomy was observed and confirmed at the surgery. The patient was released the same day.

Source:https://www.sciencedirect.com/science/article/pii/S1930043321005409
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