Patent abdominal subcutaneous veins caused by congenital absence of the inferior vena cava: a case report

Abstract

Introduction: Patent paraumbilical and abdominal subcutaneous veins are found frequently as collaterals in patients due to portal hypertension mainly in liver cirrhosis.

Case presentation: For evaluation of portal hypertension in a 72-year-old Caucasian man without liver cirrhosis, magnetic resonance imaging with gadolinium contrast-enhancement was performed and demonstrated a missing inferior vena cava. A blood return from the lower extremities was shown through enlarged collateral veins of the abdominal wall, vena azygos and hemiazygos continuation, and multiple liver veins emptying into the right cardiac atrium. We describe a rare case of abdominal subcutaneous wall veins as collaterals caused by a congenitally absent infrarenal inferior vena cava with preservation of a hypoplastic suprarenal segment.

Conclusion: Knowledge of these congenital variations can be of clinical importance and it is imperative for the reporting radiologist to identify these anomalies as they can have a significant impact on the clinical management of the patient.

Figure 1

Gadolinium-enhanced magnetic resonance imaging (MRI) of the abdomen at infrarenal level showing abdominal wall veins and absence of the inferior vena cava. AA, abdominal aorta

Figure 2

Gadolinium-enhanced MRI showing multiple paraumbilical and abdominal wall veins.

Figure 3

MRI demonstrating the hemiazygos vein (HV) and the azygos vein (AV) enlarged to compensate this anomaly. They collect the blood return from dilated paravertebral venous collaterals (PVC).

Figure 4

MRI showing renal vein collaterals (RVC) collecting venous blood return from both kidneys. AA, abdominal aorta; IVC, inferior vena cava

Figure 5

Coronal MRI showing the intrahepatic veins (IHV) empty directly into the right cardiac atrium.