Left

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GEORGE

PILLARI,’

EDWARD

Inferior

S. WIND,’

Vena

STANLEY

Diagnostic and therapeutic indications increasingly demand ready access to the inferior vena cava; anomalies of the structure, although rare, have been listed extensively by Edwards [1] and Hirsch and Chan [2]. However, the description of a solitary left side inferior vena cava with radiographic illustration has not been reported to our knowledge. References suggest the probability of a caval duplication in about 1% of the population, and it is also suggested that a solitary left inferior vena cava may exist in 0.45% of patients [2]. This brief report illustrates the course of a left side cava and its configuration in the frontal and lateral projections.

Cava L. WIENER,2

AND

MURRAY

Case

G. BARON1

Report

A 62-year-old female was admitted to the hospital with weakness, fatigue, and fever of unknown origin; lymphoma was strongly suspected. Combined cavognaphy and urography [3] were performed as the initial study for evaluation of netropenitoneal nodes. Radiography (fig. 1) demonstrated an opacified night common

iliac

vein

which

crossed

to the

left

hemipelvis

and

as-

cended as the inferior vena cava in the left panavertebral region. At the Li level, the inferior vena cava assumed an oblique course over the abdominal aorta and entered the right atrium. Urography disclosed good function in both kidneys, and the

..*1

..

,

.

;.

‘;j

;. p

I

4

4*

.

Fig. 1 . -A,

oblique

Anteropostenior

course

over

spine

projection

vena cava. Note B, Cross-table contour distortion of posterior wall of opaque column vena cava over abdominal aorta at L1-L2 level.

at L1-L2

lateral projection demonstrating secondary to position of inferior

showing

level

with

solitary

I

entrance

left side inferior to

night

atrium.

L..

Received This

June 30, 1977; accepted

work

was

supported

in part

of Radiology.

State

after revision October 31 , 1977. by grants from the Helena Rubinstein

Foundation,

University

and

Inc.

,

National

Leukemia

Fund, Inc.

and the United

,

Leukemia

Fund, Inc. ‘Department Address

11040.

‘Department

reprint requests to G. Pillani. of Medicine, State University

of New York

at Stony

Brook

Long

Island

Jewish-Hillside

of New York at Stony Brook and Long Island Jewish-Hillside

Medical

Center,

New Hyde

Medical

Center,

New Hyde Park, New York

Park,

New York

11040.

Am J Roentgenol © 1978 American

130:366-367, Roentgen

February

Ray Society

1978

366

0361 -803X/78/0200

-

0366

$02.00

CASE of the ureters lymphography clearly

course

in the pelvic

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course

was within delineated

abdominal

nodes,

of the paraaortic

normal limits. Subsequently, abnormal nodal architecture consistent

lymphatics

with

lymphoma.

The

relates

to

without

a persistence

azygos

stead,

the

segment a normal

or

embryologic

left

of the

cava

procedures tion of this the inferior

of the

hemiazygos

is important

inferior

vena

1 . Edwards

of the

variations

vein [4,

prerenal

left side

for all diagnostic

cava

supracardinal

continuation

integrity

anatomic

side left

was maintained, and the entry to the right atrium.

Knowledge vena

of this

an anatomic landmark in the studies of computed tomogra-

REFERENCES

Discussion embryogenesis

neum generally provides cross-sectional imaging phy and ultrasonography.

was normal.

At exploratory laparotomy a splenectomy was performed. The presence of a left inferior vena cava with the configuration described radiographically was confirmed.

The

367

REPORTS

In-

(hepatic)

cava of the and

5].

assumed inferior

therapeutic

which require opacification or instrumentastructure. In addition, the configuration of vena cava and its course in the retroperito-

EA: Clinical anatomy of lesser variations of the inferior vena cava, in Angiography, 2d ed, vol 1 , edited by Abrams HL, Boston, Little, Brown, 1971 , pp 453-454 2. Hirsch DM Jr, Chan KF: Bilateral inferior vena cava. JAMA 185:729-730, 1963 3. Pillani G: Combined cavography and intravenous pyelognaphy: high information yield. NY State J Med 77: 179-183, 1977 4. Holtz 5, Powers WE: Inferior vena cavagrams. Radiology 78:583-590, 1962 5. Haswell

DM,

with

accessory

119:51-54,

Bernigan

TJ Jr: Anomalous

hemiazygos

inferior

continuation.

vena cava Radiology

1962

6. Floyd GD, Nelson WP: Developmental interruption of the inferior vena cava with azygos and hemiazygos substitution. Radiology

119:55-57,

1976