Developmental Anomalies of the Inferior Vena Cava and its Tributaries: What the Radiologist Needs to Know?

Abstract

Inferior vena cava (IVC) can be involved by a wide gamut of developmental anomalies owing to its complex embryogenesis. Developmental anomalies of the IVC are not infrequent, seen in approximately 8.7% of the general population. Although most of the anatomical variations are asymptomatic, identification of these variations is important before planning any vascular surgery or interventional procedure in relation to the IVC to avoid inadvertent complications. Conventional venography has largely been replaced by noninvasive cross-sectional imaging modalities for detecting IVC abnormalities. Ultrasonography, often used for initial evaluation, is highly operator-dependent and the infrarenal part of IVC is often obscured by bowel gases. While magnetic resonance imaging is devoid of radiation risks, its use is limited due to limited availability and the frequent need for sedation. Computed tomography (CT) venography plays a pivotal role in the detection of these anomalies as it has an excellent spatial resolution along with availability of multiple postprocessing tools such as multiplanar reconstruction with generation of maximum intensity projection and volume-rendered images. This pictorial review focuses on the embryogenesis of IVC, various developmental anomalies of the IVC and its tributaries, their appearance on CT venography and conceivable clinical relevance.

Accessory tributary of the left renal vein - a case report

“…The development of the renal veins is a complex process with many possible alternative patterns of formation. The complex starts by forming the renal collar which consists of dorsal branch (intersupracardinal anastomosis) and a ventral branch (intercardinal anastomosis) [8]. This two branches drain the embryonic kidney.…”

Leadless pacemaker implantation and azygos continuation in the inferior vena cava: a case description

“…The confluence of the renal veins forms the normal suprarenal vena cava. Third, a variant can be caused by the coexistence of multiple anomalies, such as a double IVC with a retro-aortic right renal vein, interruption of the hepatic segment, and hemizygote continuation of the IVC or double IVC with retro-aortic left renal vein and azygous continuation of IVC (9,22). The relevant sites are anatomically complex, and there are limitations to stateof-the-art radiological imaging techniques, such as the high cost of SVC venography with DSA, low accuracy of magnetic resonance imaging (MRI), or inability to show veins.…”

Processing Ultrasound Scans of the Inferior Vena Cava: Techniques and Applications

“…The anatomy of the IVC can present some abnormalities in 8.7% of the world’s population [ 22 , 23 , 24 ]. These variations can occur during its genesis, which corresponds to the period between the 4th and 8th week of gestation, due to the complexity of the generation of vessels [ 23 ].…”

“…Both supracardinal veins remain in a duplicated IVC, a rare variant affecting 0.2–3% of people [ 27 ]. The majority of these anatomical variations are asymptomatic, but their identification is fundamental for the correct planning of a complex operation with no side effects [ 22 ]. US systems are used to identify these variations; however, other techniques with possible adverse effects, such as computed tomography (CT), which uses ionising radiation, or higher costs, such as magnetic resonance, are preferred because US analysis is considered user-dependent [ 22 ].…”