Duplication of Inferior Vena Cava with Left Inferior Vena Cava Draining into Right Inferior Vena Cava - A Case Report

Double inferior vena cava is a rare anomaly with incidence rate of 0.2 - 3 %. It occurs due to non-regression of both right and left supracardinal veins during embryonic development. Here, we present a case with double inferior vena cava diagnosed in a patient who underwent routine computed tomography for abdominal pain. In our case, both right and left inferior vena cava are of same caliber and we believe that duplication of IVC in our case was a result of nonregression of anastomosis between left supra subcardinal, posterior subcardinal and intersubcardinal veins resulting in persistence of left subcardinal vein. The knowledge of this anatomical variation is clinically important during retroperitoneal surgeries and vascular and radiological interventional procedures. Inferior vena cava anomalies are rare and incidentally found in asymptomatic patients who undergo radiological imaging for some other diseases. The reported incidence of duplicated inferior vena cava is 0.2 to 3 %. Among all the inferior vena cava anomalies, inferior vena cava duplication and left inferior vena cava are most commonly found. 1,2 Vascular anomalies often get encountered in computed tomography (CT) scans of abdomen and pelvis obtained with contrast injection. Familiarity with these variations is essential for correct interpretation.3 Here, we present a case of duplication of inferior vena cava with left IVC draining into right IVC at upper border of L2 vertebral level.

Utility of a modified vascular corrosion casting technique in the diagnosis of fetal total anomalous pulmonary venous connection

Total anomalous pulmonary venous connection (TAPVC) is a rare congenital cardiac malformation, and prenatal detection of TAPVC malformation remains a challenging. TAPVC can be easily missed or misdiagnosed in prenatal examinations. This study was aimed to use the modified vascular corrosion casting technique to prepare fetal cardiovascular casts with TAPVC and investigate the utility of cardiovascular casting for the demonstration of fetal TAPVC. The retrospective study enrolled twenty fetuses (22 to 29 + 4 gestational weeks) with TAPVC diagnosed by prenatal echocardiography and casting technique from May 2015 to May 2020. Pre- and postnatal medical records, including results obtained by prenatal ultrasound, postpartum computed tomography angiography, as well as anatomic and cardiovascular casting findings were carefully reviewed and analyzed. In twenty cases, 80% (16/20) had intra- or extracardiac malformations. The TAPVC types were supracardiac (n = 8), cardiac (n = 6), infracardiac (n = 4), and mixed (n = 2). The diagnosis of 1 case each of supracardiac and cardiac TAPVC was modified to partial anomalous pulmonary venous connection; additionally, 4 malformations were missed and 2 were misdiagnosed, including an anomalous left brachiocephalic vein in supracardiac TAPVC, abnormal inflow of the hepatic vein and a double inferior vena cava in infracardiac TAPVC; and bilateral ductus arteriosus in infracardiac TAPVC; a tetralogy of Fallot in cardiac TAPVC that was corrected to right ventricular double outlet; and an absence of ductus arteriosus that was misdiagnosed as slim ductus arteriosus. Comparing with ultrasound, casting technique has its own superiority in exhibiting TAPVC abnormalities, especially in certain types such as course, origin and absence abnormalities of ductus. Postpartum cardiovascular casts can accurately depict the branch structure of the heart’s larger vessels, and may be used as a clinical assessment and teaching method in complex cardiac malformations.