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Congenital anomalies of IVC

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Case based Discussion of types of IVC anomalies with embryology

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Congenital anomalies of IVC

  1. 1. By Dr M.Ajay. K & Dr Eranna Palled Please visit www.jssmcradiology.com for more cases
  2. 2. There are Spectrum of Congenital Anomalies of the Inferior Vena Cava and are usually seen in asymptomatic patients . TYPES I. Left IVC II. Double IVC III. Azygos continuation of the IVC IV. Circumaortic left renal vein V. Retroaortic left renal vein VI. Circumcaval ureter VII. Double IVC with Retroaortic Right Renal Vein and Hemiazygos Continuation of the IVC VIII. Double IVC with Retroaortic Left Renal Vein and Azygos Continuation of the IVC IX. Absent Infrarenal IVC with Preservation of the Suprarenal Segment Please visit www.jssmcradiology.com for more cases
  3. 3. I. Left IVC  It is seen as a result from regression of the right supracardinal vein with persistence of the left supracardinal vein.  Prevalence is 0.2%–0.5%.  Here left IVC joins the left renal vein, which crosses anterior to the aorta in the normal fashion, uniting with the right renal vein to form a normal right-sided prerenal IVC Please visit www.jssmcradiology.com for more cases
  4. 4. Schematic shows a left IVC terminating at the left renal vein. Please visit www.jssmcradiology.com for more cases
  5. 5. Left IVC inferior to the renal veins. Left IVC joins the left renal vein Please visit www.jssmcradiology.com for more cases
  6. 6. Left IVC crossing over aorta before uniting with right renal vein Left IVC shifted towards right side and in close relation with small pseudocyst Please visit www.jssmcradiology.com for more cases
  7. 7. Left IVC shifted towards right side compressed by large pseudocystPlease visit www.jssmcradiology.com for more cases
  8. 8. Hepatic veins draining into IVC Please visit www.jssmcradiology.com for more cases
  9. 9. II Double IVC : the left IVC typically ends at the left renal vein, which crosses anterior to the aorta to join the right IVC III Azygos continuation of the IVC : the prerenal IVC passes posterior to the diaphragmatic crura to enter the thorax as the azygos vein IV Circumaortic left renal vein : one left renal vein crosses anterior to the aorta and another crosses posterior to the aorta. V Retroaortic left renal vein : As with circumaortic left renal vein, a retroaortic left renal vein results from persistence of the dorsal arch of the renal collar Please visit www.jssmcradiology.com for more cases
  10. 10. VI Circumcaval ureter VII Double IVC with Retroaortic Right Renal Vein and Hemiazygos Continuation of the IVC. VIII Double IVC with Retroaortic Left Renal Vein and Azygos Continuation of the IVC IX Absent Infrarenal IVC with Preservation of the Suprarenal Segment Please visit www.jssmcradiology.com for more cases
  11. 11.  The infrahepatic IVC develops between the 6th and 8th weeks of embryonic life as a composite structure formed from the continuous appearance and regression of three paired embryonic veins.  In order of appearance, they are the posterior cardinal, the subcardinal, and the supracardinal veins .  Initially, all blood return from the body wall caudal to the heart proceeds through the posterior cardinal veins Please visit www.jssmcradiology.com for more cases
  12. 12.  Blood return from the viscera is conveyed by the vitelline veins , which drain the yolk sac.  Subsequently, the subcardinal veins develop ventromedial to the posterior cardinal veins and ventrolateral to the aorta.  The intersubcardinal anastomosis forms between the paired subcardinal veins anterior to the aorta and caudal to the superior mesenteric artery.  Anastomoses between the posterior cardinal and subcardinal veins develop on each side at approximately the level of the intersubcardinal anastomosis. Please visit www.jssmcradiology.com for more cases
  13. 13.  At the same time, union occurs between the right subcardinal vein and the hepatic segment of the IVC, which forms from the vitelline vein.  As the cranial portions of the posterior cardinal veins begin to atrophy,blood return from the lower extremities is shunted through the postsubcardinal anastomosis, then through the subcardinal-hepatic anastomosis to the hepatic segment of the IVC. This process establishes the prerenal division of the IVC. Please visit www.jssmcradiology.com for more cases
  14. 14.  The next major development is the appearance of the paired supracardinal veins,which lie dorsomedial to the posterior cardinal veins and dorsolateral to the aorta.  Initially, multiple anastomoses form between the posterior and supracardinal veins.  On each side, a suprasubcardinal anastomosis develops from union of the postsupracardinal and the postsubcardinal anastomoses.  In addition, intersupracardinal anastomoses develop dorsal to the aorta.  The supracardinal veins then separate into cranial (azygos) and caudal (lumbar) ends. Please visit www.jssmcradiology.com for more cases
  15. 15.  Meanwhile, inferiorly, anastomoses develop between the two posterior cardinal veins and between the posterior and lumbar supracardinal veins.  With further atrophy of the posterior cardinal veins, blood return from the lower extremities is shunted through the supracardinal system to the suprasubcardinal anastomosis, then to the prerenal division of the IVC.  In addition, blood return from the left side of the body is shunted to the right across the intersupracardinal and interpostcardinal anastomoses.  Finally, the left supracardinal vein is one of the last veins to disappear, although Huntington and McLure (4state that the vessel does not so much atrophy as become incorporated into the right supracardinal vein by coalescence of the multiple anastomoses. Please visit www.jssmcradiology.com for more cases
  16. 16.  In summary, the normal IVC is composed of four segments: hepatic, suprarenal, renal, and infrarenal.  The hepatic segment is derived from the vitelline vein.  The right subcardinal vein develops into the suprarenal segment by formation of the subcardinal-hepatic anastomosis. Please visit www.jssmcradiology.com for more cases
  17. 17.  The renal segment develops from the right suprasubcardinal and postsubcardinal anastomoses.  It is generally accepted that the infrarenal segment derives from the right supracardinal vein, although this idea is somewhat controversial .  In the thoracic region, the supracardinal veins give rise to the azygos and hemiazygos veins.  In the abdomen, the postcardinal veins are progressively replaced by the subcardinal and supracardinal veins but persist in the pelvis as the common iliac veins. Please visit www.jssmcradiology.com for more cases
  18. 18.  Since the embryonic ureter passes posterior to the posterior cardinal veins and anterolateral to the supracardinal vein, formation of the postsupracardinal anastomosis inferiorly and the suprasubcardinal anastomosis at the level of the kidney allows development of a potential periureteric venous ring.  The renal collar is formed from the intersupracardinal anastomosis dorsally, the intersubcardinal anastomosis and postsubcardinal anastomoses ventrally, and the suprasubcardinal anastomosis laterally. The embryonic kidneys are initially drained by paired ventral and dorsal limbs.  Ordinarily, both dorsal limbs regress.  On the right side, the ventral limb is incorporated into the lateral wall of the renal segment of the IVC.  On the left side, the ventral limb and the anterior limb of the renal collar form the normal adult left renal vein. Please visit www.jssmcradiology.com for more cases
  19. 19. THANK YOU Please visit www.jssmcradiology.com for more cases

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