Mirror-image type III complete duplication of inferior vena cava: a distinct classification subtype or a variant of an existing one?

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Abstract

The article presents a case of duplication of the inferior vena cava detected as an incidental finding in a 62-year-old patient who underwent computed tomography of the chest and abdomen for rectal cancer. Imaging revealed duplication of the inferior vena cava, with the left trunk exceeding both the right trunk and the aorta-crossing trunk in diameter. Both trunks were formed by anastomosing common iliac veins. Duplication of the left renal artery and vein was also noted; the lower left renal vein drained directly into the left trunk of the inferior vena cava, which then joined the upper renal vein and crossed the aorta as a single trunk before merging with the right inferior vena cava. The further course of the inferior vena cava to the right atrium was anatomically normal. The currently existing classification of inferior vena cava duplication does not provide a definitive description for the variant identified in this patient, creating difficulty in formulation of the medical conclusion. The observed anatomy most closely corresponded to Type III duplication, in which the right trunk normally exceeds the left and the aorta-crossing trunk in diameter. Based on the radiologic features and morphometric measurements of the duplicated inferior vena cava trunks, we assume that this represents a rare mirror-image anatomic variant of Type III duplication, in which the left trunk has the greatest diameter. Scientific data review revealed two additional reports describing similar duplication cases (three previously reported patients in total). In one publication this variant was suggested as a Type IV duplication, whereas in another, classification was not provided. Whether this anatomical pattern should be considered an independent Type IV duplication or a mirror-image modification of Type III remains debatable and merits discussion from an anatomical nomenclature standpoint. However, larger patient samples would be required, which is challenging owing to the rarity of the present anatomic variant.

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About the authors

Stanislav V. Shershnev

City Hospital No. 4 of Sochi

Email: st.xray@yandex.ru
ORCID iD: 0000-0003-0367-3318
SPIN-code: 8695-7123
Russian Federation, Sochi

Ekaterina I. Yudina

Children Hospital of Ussuriysk

Email: katerina-lazareva-98@mail.ru
ORCID iD: 0009-0008-6100-7085
SPIN-code: 6225-9542
Russian Federation, Ussuriysk

Victor V. Ipatov

Military Medical Academy

Email: vmeda-nio@mil.ru
ORCID iD: 0000-0002-9799-4616

MD, Cand. Sci. (Medicine)

Russian Federation, Saint Petersburg

Aleksey A. Semenov

Military Medical Academy

Author for correspondence.
Email: vmeda-nio@mil.ru
ORCID iD: 0000-0002-1977-7536
SPIN-code: 1147-3072

MD, Cand. Sci. (Medicine), Associate Professor

Russian Federation, Saint Petersburg

Valentina A. Cheprakova

Military Medical Academy

Email: vmeda-nio@mil.ru
ORCID iD: 0009-0007-9269-4896

MD, Cand. Sci. (Medicine)

Russian Federation, Saint Petersburg

Ornella D. Khugaeva

Military Medical Academy

Email: vmeda-nio@mil.ru
ORCID iD: 0009-0002-4402-3485

Student

Russian Federation, Saint Petersburg

Ruslan Z. Sutatov

Military Medical Academy

Email: vmeda-nio@mil.ru
ORCID iD: 0009-0007-3780-2786
SPIN-code: 4789-7405

Student

Russian Federation, Saint Petersburg

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2. Fig. 1. Computed tomography images of the abdominal organs in the axial (a–e) and coronal (f) planes in the native phase. There are two trunks of the inferior vena cava, formed from the fusion of the iliac veins. The left trunk of the IVC continues to the left renal vein, merges with it, bypassing the aorta in front, and flows into the right trunk of the IVC, further forming a single vessel throughout its entire length.

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3. Fig. 2. Computed tomography images of the abdominal organs in the axial plane during the arterial phase of contrast enhancement from the level of the left renal vein to the confluence of the iliac arteries. Fig. b shows the confluence of the accessory renal vein into the left trunk of the NPV. Fig. c and d show the ratio of the sizes of the right and left trunks of the NPV in relation to each other and to the aorta. Fig. e and f show that both trunks of the NPV are not direct continuations of the common iliac veins, but are formed from the confluence of their existing bilateral anastomoses.

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4. Fig. 3. Computed tomography images of the abdominal organs in the axial (a–d) and coronal (e, f) planes during the venous phase of scanning. The dimensions of the common trunk of the inferior vena cava after fusion (a), the isthmus (b), the right and left trunks (c–e) are shown, as well as the anastomoses of the common iliac veins with the subsequent formation of the trunks of both inferior vena cavae (arrows) (e).

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