Figure 1: axial image through heart showing large azygous vein entering the right atrium
Figure 2: cranial abdomen (T13 level) showing aberrant vena cava emptying into the azygous vein
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CASE REPORT #44 Feb. 2008 |
An 11yr FS Weimeraner was presented for CT imaging of the thorax and abdomen to determine the extent of a liver
mass discovered on abdominal ultrasound and to evaluate the lungs for metastatic disease. The patient had increased
liver enzymes and was azotemic. Ultrasound also suggested the presence of ureteral calculi and found an abnormal,
undefined “tubular” structure near the right kidney.
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Figure 1: axial image through heart showing large azygous vein entering the right atrium |
Figure 2: cranial abdomen (T13 level) showing aberrant vena cava emptying into the azygous vein |
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Figure 3: mid abdomen showing abberant abdominal vena cava diving around the right kidney |
Figure 4: caudal abdomen showing initial diversion of the abdominal venal cava laterally |
The CT images revealed a solitary hepatic mass in the right lateral lobe of the liver with no evidence of metastatic disease in the lungs or remainder of the abdomen. The patient also had mineral dense calculi in the right ureter, both renal pelvic regions and the neck of the urinary bladder. There was also an anomalous path of the abdominal vena cava with it diving ventral and lateral to the right kidney and connecting with the azygous vein immediately caudal to the diaphragm at the level of T13. There was no caudal vena cava adjacent to the aorta from immediately cranial to the kidneys to the liver. There was a reduced size vena cava segment from the level of the liver/hepatic veins to the right atrium.
Findings were consistent with a resectable hepatic mass as well as a ureterolith, bilateral renal pelvic calculi, a cystic calculus, and chronic renal disease. Also noted, and focus of this case report, was an anomalous path and “discontinuation” of the cranial abdominal portion of the caudal vena cava, with connection of the caudal abdominal vena cava with the azygous vein.
Patient recently had a successful surgical removal of the diseased right lateral liver lobe and bladder calculus. Patient was doing well when last report was received. Knowledge of the abnormal abdominal vascular anatomy prior to surgery assisted surgical planning and reduced surgery time.