Inferior vena cava on left side with left renal cell carcinoma

Inferior vena cava on left side with left renal cell carcinoma

INFERIOR WITH LEFT MIKIO NAMIKI, VENA CAVA ON LEFT RENAL CELL CARCINOMA M.D. HIROSHI ITOH, M.D. TOSHIAKI YOSHIOKA, SIDE HIROAKI ITATANI, ...

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INFERIOR WITH

LEFT

MIKIO

NAMIKI,

VENA

CAVA ON LEFT

RENAL

CELL

CARCINOMA

M.D.

HIROSHI ITOH, M.D. TOSHIAKI YOSHIOKA,

SIDE

HIROAKI

ITATANI,

JUN UEDA, M.D.

M.D.

M.D.

KAZUO HARA, M.D.

From the Departments of Urology and Radiology, Sumitomo Hospital, Osaka, Japan

ABSTRACT -A case of unilateral inferior vena cava (WC) on the left side with left renal cell carcinoma and two polar veins is presented. Preoperative computerized tomogram (CT) and angiogram showed IVC on the left side and tumor thrombus in the left renal vein; that information was helpful during radical nephrectomy.

A fifty-two-year-old man was admitted to our clinic with a complaint of fatigue. He had a mass in the left hypochondrium. Laboratory data were within normal limits, except for microscopic hematuria. Intravenous pyelography (IVP) showed a space-occupying lesion in the lower part of the left kidney pressing the collecting system upward. Abdominal CT demonstrated a left renal tumor occupying the lower pole and an IVC on the left side of the aorta (Fig. 1A). Coronal reconstruction of the abdominal CT (Fig. IB) demonstrated that the left IVC crossed the aorta after draining the left renal vein and joined the suprarenal part of a normal right IVC draining the right renal vein. Selective left renal arteriogram showed hypervascular renal tumor in the lower half of the left kidney. Inferior vena cavogram (Fig. 1C) confirmed the findings of the CT, and selective left renal venogram revealed a defect due to the tumor thrombus in the left renal vein. A radical left nephrectomy was performed transperitoneally. The radiographic findings were confirmed, but in addition there were two polar veins from the lower part of the left kidney, draining into the IVC directly (Fig. 1D). The

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operation was completed successfully, and convalescence was uneventful. Comment Congenital anomalies of the vena cava are not frequent, and previous reports were mainly based on cadaver dissection. 1 However with the advance of angiography more reports of these morphogenetic variations have appeared in the literature. 2-4 The inferior vena cava is formed through rather complicated embryogenesis that involves development, regression, anastomosis, and replacement of three pairs of venous channels: posterior cardinal, subcardinal, and supracardinal. It is composed of four segments: hepatic segment derived from the right vitelline vein, prerenal segment from the right subcardinal vein, renal segment from the right subsupracardinal anastomosis, and postrenal segment from the right supracardinal vein. In the classification of congenital anomalies of the IVC,5 postrenal segment is divided into four types: Type A corresponds to the retrocaval ureter or circumcaval ureter; Type B corresponds to the normal IVC; Type C corresponds

UROLOGY

/

SEPTEMBER

1932

/

VOLUME

XX, NUMBER

3

.FIGURE 1. (A) Abdominal CT demonstrates left renal tumor and W C on left side of aorta. (Bj Coronal reconstruction of abdominal CT clearly depicts left IVC crossing aorta after draining left renal vein. (C) Inferior vena caoogram shows that abdominal IVC transposed to left side crosses the vertebrae to upper right. (D) Intraoperatlce photograph. W C is situated on left side of aorta. Renal vein and one of two polar veins draining into IVC directly and independentEy are held by tapes.

to IVC on the left side; and Type BC corresponds to double IVC. IVC on the left side is explained as a persistence of the left supracardinal vein, and the incidence found in autopsy is 0.2 per cent.6 However radiographic reports of IVC on the left side are few, and furthermore, a case of WC on the left accompanied with left renal tumor has not been reported as yet. Associated anomaly in this case is two polar veins entering the left kidney from IVC directly and independently. Although supernumerary veins do occur, they are found much less frequently than multiple renal arteries. Reis and Esenther” described that independent polar veins occurred in 1.2 per cent of the cadavers and were always from the right kidney, whereas independent polar veins from the left kidney were never found.

5-2-2. Nakanoshima Kita-ku Osaka 5,30, Japan (DR. NAMIKI)

Refer-ewes 1. Becker FF: A singular left sided inferior vena caw, Aant. Rec. 143: 117 (1962). 2. Haswell DM. and Berrigan TJ: Anomalous inferior vena cava with accessory hemiazygos continuation, Radiology 119: 51 (19%). 3. Pillari G, Wind ES, Wiener Sl.. and Baron MD: Left inferior vena rava, AIR 130: 366 (1978) 4. Hayashi M, Kume ?, and Nihira H: Abnormalities of renal venous system and unexplained renal hematturia, J, Carol. 124: 12 (19?30). 5. Chuang VP, Mena CE, and Hoskins PA: Congenital anomalies of the inferior vena cava. Review of embryogenesis and presentation of a simplified classification, Br. J. Radiol. 47: 206 119741. 6. Rrir RH, and Exnther G: Variations in the pattern of renal vessels and their relation to the type of posterior vena cava in man, Am. J. Anat. 104: 295 11959).