An unusual case of abdominal aneurysm: Inferior vena cava aneurysm - A case report

Abstract

Venous aneurysms are rarely reported in the literature since they are usually asymptomatic and incidentally detected due to complications such as thrombosis and pulmonary embolism. Often an inferior vena cava (IVC) aneurysm is detected by imaging studies performed for other causes. We report a case of large Type II IVC aneurysm associated with severe pectus excavatum in an asymptomatic man detected on routine 2D echocardiography. Focal narrowing of the IVC at the level of xiphisternum detected in multi-slice computed tomography might be the possible etiology for IVC aneurysm. <Learning objective: Even though inferior vena cava aneurysms are rare, they can easily be diagnosed non-invasively by 2D echocardiography, ultrasound, and multi-slice computed tomography. The proximal obstruction of inferior vena cava by the xiphisternum as a complication of a severe form of pectus excavatum resulting in inferior vena cava aneurysm is probably a rare and possibly the only reported case in the literature.>.

Keywords: 2D echocardiography; Aneurysm; Computed tomography; Inferior vena cava.

Fig. 1

Anteroposterior view of the patient showing pectus excavatum.

Fig. 2

(A) Chest X-ray posteroanterior view showed (arrows) 1. Vertical anterior ribs (heart-shaped), 2. Horizontal posterior ribs 3. Displacement of heart towards the left and blurring of right heart border. (B) Electrocardiogram was normal with a heart rate of 85 beats/min.

Fig. 3

(A) Gray-scale images in 2D echocardiogram showing aneurysmal dilatation of inferior vena cava (arrow A) and proximal obstruction to the inferior vena cava (arrow B). Color Doppler ultrasonography images showing (B) aneurysmal dilatation of the inferior vena cava and (C) dilated mid and left hepatic vein (arrow).

Fig. 4

Coronal section of post-contrast phase computed tomography showing (A) proximal focal narrowing at the level of the xiphisternum (anteroposterior diameter: 9 mm and cross-sectional area: 0.9 cm²) (B) fusiform aneurysmal dilatation of the infra-hepatic segment of inferior vena cava measuring 6.6 × 4.7 cm extending to a length of 12.6 cm with associated dilatation of its tributaries and multiple venous collaterals (C) fusiform aneurysmal dilatation of the infra-hepatic segment of inferior vena cava in the axial section. (D) and (E) Axial sections showing one dilated venous collateral and collateral draining to azygos vein.