Double Inferior Vena Cava: A Case Report Case Report

Abstract

Citation: Altaf J, Rashid T, Husian M, Alam M, Ahmad M. Double Inferior Vena Cava: A Case Report. Am J Surg Tech Case Rep. 2020;1(1):1005. Abstract Double inferior vena cava is a congenital abnormality that is present from birth. The condition is asymptomatic and usually diagnosed incidentally either on imaging study for some other medical reasons or during surgeries in the retro peritoneum like RPLND. People who are diagnosed to have double inferior vena cava does not need any treatment, however caution is needed when surgeries are performed in such patients to avoid any additional injury.

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American Journal of Surgical Techniques and Case Reports
2020 | Volume 1 | Article 1005
021
© 2020 - Medtext Publications. All Rights Reserved.
Double Inferior Vena Cava: A Case Report
Case Report
Javed Altaf, Tajamul Rashid*, Musharraf Husian, Muniza Alam and Manzoor Ahmad
Department of Surgery, Hamdard Institute of Medical Sciences and Research, New Delhi, India
Citation: Altaf J, Rashid T, Husian M, Alam M, Ahmad M. Double
Inferior Vena Cava: A Case Report. Am J Surg Tech Case Rep.
2020;1(1):1005.
Copyright: © 2020 Javed Altaf
Publisher Name: Medtext Publications LLC
Manuscript compiled: July 15th, 2020
*Corresponding author: Tajamul Rashid, Department of Surgery,
Hamdard Institute of Medical Sciences and Research, New Delhi,
India, Tel: +91 7006473796; E-mail: doc.tajamuul@gmail.com
Abstract
Double inferior vena cava is a congenital abnormality that is present from birth. e condition is asymptomatic and usually diagnosed incidentally either on
imaging study for some other medical reasons or during surgeries in the retro peritoneum like RPLND. People who are diagnosed to have double inferior vena
cava does not need any treatment, however caution is needed when surgeries are performed in such patients to avoid any additional injury.
Keywords: Inferior vena cava; Ovarian mass; Cytoreductive surgery; RPLND
Introduction
Overall prevalence of double inferior vena cava in general
population is 0.2% to 3% [1]. is congenital variation is caused by an
unusual embryological development of the inferior vena cava [2,3].
e condition is asymptomatic and usually diagnosed incidentally
either on imaging studies for some other medical reasons or during
surgeries in the retro peritoneum like RPLND. People who are
diagnosed to have double inferior vena cava does not need any special
treatment, however caution is needed when surgeries are performed
in such patients to avoid any additional injury. People with double
inferior vena cava who develop blood clot or have any episode of
pulmonary embolism may need two IVC lters to prevent further
complications [4,5]. On cross sectional imaging double IVC can be
mistaken with a retroperitoneal mass or paravertebral lymph-node
enlargement [6]. Lack of knowledge of these variations might result
in a misinterpretation of the radiologic images of double IVC, leading
to surgical errors such as bleeding during RPLND. is anatomical
variation is also important during whole organ transplantation or
radical nephrectomy.
Case Presentation
We present a case of double inferior vena cava in a 47 years old
postmenopausal married female with 3 living issues. Patient had no
medical comorbidities and has no signicant family history. Patient
presented to our OPD with chief complaints of increasing abdominal
distension for a period of 8 months. On abdominal examination there
was a large approximately 10 cm × 15 cm mass arising from pelvis.
Patient was admitted and was evaluated. CECT whole abdomen was
done which was suggestive of right ovarian mass of 15 cm × 15 cm
with multiple enlarged periarotic, paracaval and pelvic lymph nodes
with omental thickening and minimal ascitis. CECT could not pick
the nding of double IVC. Liver and spleen was grossly normal. CA
125 levels were grossly raised. Patient was diagnosed as a case of
stage 3 ovarian malignancy. Patient was planned for cytoreductive
surgery with RPLND. Cytoreductive surgery (Hysterectomy with B/L
salpingo-oopherectomy with omentectomy& peritoneal excision) was
done via a midline laparotomy incision. is was followed by RPLND.
During RPLND double inferior vena cava was noticed one on either
side of abdominal aorta (Figure 1).
Figure 1: Inferior Vena Cava (IVC).
Discussion
Double inferior is not a common entity. It is usually encountered
during cross-sectional imaging for some other medical condition.
Intra-operatively this condition is found in 0.2% and 0.6% of
patients [7]. e normal IVC is composed of four segments: hepatic,
suprarenal, renal, and infra-renal. Embryological development of IVC
begins at the 6th week of gestation and involves 3 pairs of primitive
veins (posterior cardinal, subcardinal, and supracardinal veins) that
appear and regress shaping the nal IVC. e posterior cardinal veins
appear and remain in the pelvis as the common iliac veins, the right
supracardinal vein persists to form the infrarenal IVC, and the right

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American Journal of Surgical Techniques and Case Reports
2020 | Volume 1 | Article 1005
subcardinal vein persists to develop into the suprarenal segment
by formation of the subcardinal-hepatic anastomosis while the le
subcardinal vein and the le supracardinalvein regress completely
[1,7,8]. e renal segment develops from the anastomosis between
the subcardinal and supracardinal veins while the hepatic segment
derives from the right vitelline vein.
Any developmental deviation from the above process determines
at least 14 dierent anatomic anomalies of the IVC. Bass et al. [1]
reported, major anomalies are double IVC (with a prevalence of
0.2% to 3%), le IVC (0.2% to 0.5%), retroaortic le renal vein
(2.1%), circumaortic le renal vein (8.7%), and absence of the hepatic
segment of the IVC with azygos continuation of the IVC (0.6% of
cases). Recognition of this anomaly is clinically relevant during
retroperitoneal surgery or vascular interventional procedures so as to
avoid recurrent pulmonary embolism following placement of an IVC
lter [9]. Particular caution is needed in planning cardiopulmonary
bypass, in catheterizing the heart, and in the dierential diagnosis of
right-sided para-tracheal mass and paravertebral lymphadenopathy
in patients with this variation [10].
In addition, it is necessary for radiologists to prevent
misinterpretation of aberrant vessels as paravertebral lymph node
enlargement. Multi-detector CT technique is the preferred method for
imaging the congenital vascular anomalies of IVC since it is less costly,
less invasive than conventional angiography, fast, easily applicable,
and reliable in terms of identication of thoraco-abdominal vascular
structures.
Conclusion
Double inferior vena cava is an uncommon congenital variant.
Awareness of this variation is clinically relevant to surgeons frequently
operating in retroperitoneal areas and interventional cardiologists
to avoid additional injuries. In addition radiological awareness is as
much important to avoid any diagnostic error.
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