Deviations in the complex embryogenesis of the IVC may result in an overall 4% of anatomic variants in the general population. The patients typically present lower extremity edema and subcutaneous collateral veins in the abdominal wall. Treatment involves surgical intervention such as left renal vein transposition, where the left renal vein is moved in order to cease the compression, or a nephrectomy, where all or part of the kidney is removed. It was established that in past hepatic part of IVC fall from 7 to 23 veins. 5-6 branches unite to form the main Renal Veins The renal veins are anterior to the renal arteries on either side of the abdomen. With left IVC, the IVC is positioned to the left of the abdominal aorta. Similar anatomic detail can be seen on MRI as is seen on CT. Steady-state free precession (SSFP; also termed, “Black blood” MRI pulse sequences, in which the vessel lumen is dark secondary to the washout phenomenon (also termed, Reporting: Information for the Referring Physician. The first main vein is the longest, most variable vein and is referred to as the right hepatic vein. In female patients, enlarged gonadal and pelvis veins can simulate pelvic congestion syndrome. The liver can be divided into 9 segments and the right hepatic vein drains segments VI and VII as well as parts of segments V and VIII. Two thirds of the leiomyosarcomas appear predominantly as extraluminal growth and the other one third appear mostly as intraluminal tumors. Right Renal Vein . The IVC has a retroperitoneal course within the abdominal cavity. Knowledge of the IVC embryogenesis is necessary for a better understanding of the IVC anatomic aberrations. Retroaortic left renal vein: The renal vein crosses posterior to the aorta to join the IVC. It then joins the superior vena cava at its normal location in the right paratracheal space. The IVC is formed from the two common iliac veins at the L5 vertebral level. CHAPTER 110 Inferior Vena Cava and Its Main Tributaries, Carlos Cuevas, Manjiri Dighe, Mariam Moshiri. On the left, they drain into the renal vein which in turn drains into the inferior vena cava. 3 Anterior hepatic veins -RHV-MHV-LHV. The very first and 2nd lumbar veins finish in the ascending lumbar vein. It is partially covered anteriorly by the peritoneal membrane. The right inferior vena cava was formed in the usual way by the junction of the right and left common iliac veins, and from thence upward it pursued the ordinary course of the inferior vena cava on the right of the aorta. Thrombosis of the ovarian vein can occur postpartum and can result in a pulmonary embolism (PE). Treatment also involves a reduction in proteinuria, for patients with nephrotic syndrome, with ACE inhibitors. Provide the information when requesting an imaging examination because this may aid in selecting the proper protocol for the imaging examination. The tributaries of the inferior vena cava differ from the branches of the aorta in two respects. It opens into its right anterolateral aspect and is usually double in its course. PLAY. Gadolinium-enhanced MRI is arguably the most reliable method to assess vascular patency. The IVC receives a number of tributaries including common iliac, lumbar, renal, right adrenal, and hepatic veins. Although the diagnosis of left renal vein variants is easy to detect, in the right kidney the findings of a double vein can be more subtle and sometimes may be overviewed. In turn, the iliac vein and other tributaries are fed by even smaller veins, and still smaller veins feed those veins, ensuring that deoxygenated blood from every cell of the body is circulated back through the heart. It receives tributaries from: Common iliac veins – formed by the external and internal iliac veins. Multidetector row CT (i.e., MDCT) has become the modality of choice for IVC assessment. Are you ready to learn? Knowing the tributaries of the inferior vena cava can be important in the surgical field. Read more. Tributaries of Inferior Vena Cava. The retroperitoneal space where the IVC is located can communicate with the perirenal spaces and the anterior and posterior interfascial spaces. There may be variants in this anatomy and there may be significant discrepancy in the size of the two IVCs. The inferior vena cava, the largest vein in the human body, transports blood from the lower limbs, most of the back, the abdominopelvic viscera and the abdominal walls to the right atrium. Ultrasound imaging with color flow Doppler imaging can be diagnostic for a variety of IVC anomalies. The hepatic and right adrenal veins drain directly into the right atrium. The remaining congenital IVC anomalies are rare. Dorsal tributaries drain blood from the lumbar back and skin whereas abdominal tributaries drain blood from the anterior, posterior and lateral abdominal walls as well as from the parietal peritoneum. Even though the clinical assessment of IVC pathology presents several limitations, the revolutionary advances we have seen in computed tomography (CT) and magnetic resonance imaging (MRI) technology allow us to achieve excellent noninvasive assessments of these structures. Because the inferior vena cava is located to the right of the midline, drainage of the tributaries is not always symmetrical. Superior pancreaticoduodenal veinjoins the portal vein behind the very first part of duodenum. Visceral tributaries of the inferior vena cava: a) adrenal veins b) inferior diaphragmatic veins c) testicular vein d) renal vein e) lumbar veins 493. The inferior cava is the large collecting vessel for deoxgenated blood drained from the lower limbs, pelvis and abdomen. On the right, the gonadal veins and suprarenal veins drain into the inferior vena cava directly. The renal segment forms via anastomosis of the right supra-subcardinal and post-subcardinal veins. The venous congestion caused by the tumor can cause acute organ failure of the liver, kidneys, and other organs depending on its location, growth rate, and the development of bland thrombus aggravating the problem. The IVC was to the right of the spine, smaller than normal , and ended abruptly a short distance above the right renal vein at the level of the first lumbar vertebra . It is formed by the union of the common iliac veins at the level of the body of L5. Intravenous contrast media may be administered to confirm venous patency, presence of a stenosis, visualization of collaterals, and/or venous tumor invasion. Inferior Vena Cava Tributaries. The IVC’s function is to carry the venous blood from the lower limbs and abdominopelvic region to the heart.. Anatomic variants of the IVC can be seen in association with other anomalies. 492. This can cause venous congestion, which can increase venous pressure and damage the liver. The inferior vena cava (IVC) is the largest vein of the human body. Thrombosis can also occur in the renal veins and is most common in patients with nephrotic syndrome, a kidney disorder characterised by proteinuria (protein in the urine), oedema and hypercholesterolemia. Log In or, Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), on Inferior Vena Cava and Its Main Tributaries. A, CECT of the abdomen shows a left renal vein crossing anterior to the aorta (arrow). Hepatic portal system. – Write. Course: The IVC has a retroperitoneal course within the abdominal cavity The IVC is formed by the confluence of the two common iliac veins at the L5 vertebral level. The IVC is composed of four segments which form during the 6 to 8 weeks postconception.2,3 This is due to continuous appearance and regression of three paired embryonic veins, which include the posterior cardinal veins, the subcardinal veins, and the supracardinal veins. With the absence of infrarenal IVC or entire IVC, patients may present with venous insufficiency of the lower extremities or idiopathic deep venous thrombosis. The inferior vena cava is ne of two great veins, known as vena cavae, in the general or systemic circulatory system of the body, the other being the superior vena cava.The inferior vena cava is the widest vein in the body and one of the longest; it conveys most of the blood from the body below the diaphragm to the right atrium of the heart. Etiology and Pathophysiology (Including any Special Anatomic Considerations). Duplication of IVC with retroaortic left renal vein and azygos continuation of IVC: There are two infrarenal IVCs. FIGURE 110-4 Circumaortic left renal vein. With the absence of infrarenal IVC or entire IVC, patients may present with venous insufficiency of the lower extremities or idiopathic deep venous thrombosis. The left inferior phrenic vein drains higher than its right counterpart and is found superior to the oesophageal opening in the diaphragm. The detection of anatomic variants in the renal veins is particularly important at the time of surgical planning for kidney donation. I Like To Rise So High Iliac Lumbar Testicular Renal Suprarenal Hepatic vein. The inferior vena cava is responsible for the venous drainage of all structures below the diaphragm. Terms in this set (16) Inferior Vena Cava. Parietal inflows are formed in the walls of the abdominal cavity and pelvic cavity. It is recommended to ensure that there is at least a 2-minute delay between intravenous contrast administration and CT scanning because this will improve the likelihood for homogeneous enhancement of the IVC. Congenital anomalies of IVC are due to interruption of normal regression or lack of development of the different segments. It runs along the right side of the vertebral column with the aorta lying laterally on the left. The patient should be informed to also alert any treating physician. Tributaries. It runs along the right side of the vertebral column with the aorta lying on the left. FIGURE 110-3 Azygos-hemiazygos continuation of the IVC with duplication of the infrarenal IVC. Splenic . Therefore, this syndrome can result in liver disease if not treated. The best imaging consideration would be CT with multiplanar reformation. The inferior vena cava (IVC) and major tributary veins are retroperitoneal structures with unique anatomic and developmental characteristics that offer special challenges for clinical and radiologic assessment. Flashcards. Lumbales, only 3-4) are formed in the walls of the abdominal cavity. Contrast-enhanced CT shows two IVC—one on each side of the aorta. A useful mnemonic to remember the tributaries of the inferior vena cava is: I Like To Rise So High Mnemonic I: common iliac veins L: lumbar veins T: right testicular (gonadal) vein R: renal veins S: suprarenal veins H: hepatic veins A mnemonic which can be used to remember these tributaries is as follows: 'I Like To Rise So High'. hemiazygos continuation of the IVC: often occurs with duplicated IVCs; interazygos vein: occurs when forming a common trunk with the accessory hemiazygos vein anterior to the aorta 6 Occasionally, a palpable mass may be felt in the right iliac fossa. • If the suprarenal IVC is present, it receives blood from the renal veins. 110-1). 3 abdominal wall tributaries: inferior phrenic vein and third and fourth lumbar veins. C, Thick coronal MIP reformat shows the duplicated infrarenal IVC with the left (arrow) draining into the left renal vein and crossing behind the aorta (black arrow). The circumaortic venous ring and retroaortic left renal vein are related to aberrant development of the renal segment. The middle hepatic vein usually drains segments IV, V and VIII, whilst the left hepatic vein drains segments II and III as well as segment IV on occasion. First, those corresponding to the anterior visceral branches of the aorta form the portal vein, which passes into the liver at the porta hepatis. Anatomic anomalies can occur if the involution of the dorsal veins does not occur, including retrocaval and circumaortic left renal vein and duplication of right renal vein. Composed behind the neck of pancreas, the portal vein is unified by superior mesenteric veinand splenic vein in the level of L2 It runs upward and a little to the right supporting the neck of pancreas, then ascends posterior to the very first part of the duodenumto goes into the right free edge of the lesser omentum. Primary IVC tumors (leiomyosarcomas) are very rare with only one large series published in the literature. Multiplanar images (axial, coronal, sagittal, and oblique) better demonstrate the extent of IVC anomalies and their relationship with other anatomic structures. With retroaortic left renal vein, an increased incidence of testicular varicoceles has been reported, presumably due to compression of the left renal vein by the abdominal aorta. The new phased array coils built with 12 and 16 channels can deliver better coverage of the abdomen and pelvis and provide increased signal-to-noise ratio. Like with the ovarian vein, it can also cause a PE, so prophylaxis with anticoagulants is usually carried out. and grab your free ultimate anatomy study guide! IVC tributaries. It passes posterior to the diaphragmatic crura, enters the thorax as the azygos vein, and then joins the superior vena cava at the azygos arch. 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