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Isolated interrupted inferior vena cava with azygos continuation mimicking paraesophageal lymph node enlargement

U Yilmaz1, H Halilcolar, I Unsal

  • 1Division of Pulmonary Medicine, Suat Seren Chest Disease and Surgery Training and Research Hospital, Izmir, Turkey. drufukyilmaz@e-kolay.net

Monaldi Archives for Chest Disease = Archivio Monaldi Per Le Malattie Del Torace
|March 31, 2007
PubMed

Insights

Interrupted inferior vena cava with azygos continuation is a rare congenital anomaly. This case highlights its incidental diagnosis in a patient with lung carcinoma, mimicking lymphadenopathy on initial CT scans.

Area of Science:

  • Cardiovascular Imaging
  • Thoracic Radiology
  • Congenital Anomalies

Background:

  • The inferior vena cava (IVC) is a major vein responsible for returning deoxygenated blood from the lower and middle body into the right atrium of the heart.
  • Interrupted inferior vena cava with azygos continuation (IIVC-AC) is a rare congenital anomaly where the infrarenal IVC fails to develop, with blood rerouted via the azygos vein.

Observation:

  • A patient diagnosed with lung carcinoma presented with findings initially suggestive of paraesophageal lymphadenopathy on unopacified computed tomography (CT) scans.
  • Contrast-enhanced spiral CT scans revealed a dilated azygos vein.

Findings:

  • The absence of a definable inferior vena cava was confirmed.
  • The dilated azygos vein represented the compensatory pathway for venous return, characteristic of interrupted inferior vena cava with azygos continuation.
  • This anomaly was identified as an incidental finding in the context of lung carcinoma staging.

Implications:

  • Accurate identification of IIVC-AC is crucial for surgical planning and interpretation of imaging studies in patients with thoracic malignancies.
  • Radiologists must be aware of this anomaly to avoid misdiagnosis, particularly differentiating it from pathological lymphadenopathy.
  • Understanding venous anomalies can improve diagnostic accuracy and patient management in oncology.

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