Our engaging videos, interactive quizzes, in-depth articles and HD atlas are here to get you top results faster. 3. Course: The IVC has a retroperitoneal course within the abdominal cavity The IVC is formed by the confluence of the two common iliac veins at the L5 vertebral level. Various other veins drain into the IVC along its course before it passes through the diaphragm at the caval hiatus at the T8 level. A, Contrast-enhanced CT of the abdomen depicts axial images at the level of the renal veins showing normal location and size of the IVC located to the right of the aorta. On the left, they drain into the renal vein which in turn drains into the inferior vena cava. It is always important to keep in mind that MRI examinations do not expose the patient to ionizing radiation. Some problems that can develop within the inferior vena cava include compression and thrombosis. Note the absence of the intrahepatic IVC and how the hepatic veins drain directly into the right atrium (arrow). Retroaortic left renal vein: The renal vein crosses posterior to the aorta to join the IVC. Anatomy/CV. Signs and symptoms include abdominal pain, jaundice (yellowing of the skin), hepatomegaly (enlarged liver) and ascites (fluid in the peritoneal cavity). It may be double and has a branch, which drains into the left suprarenal or renal vein. Version 2.69 36790-4MRA Inferior vena cava + tributariesActive Term Description This study is used to image the inferior vena cava (IVC) and its tributaries. 492. Tributaries of the IVC are the paired lumbar and renal veins and the hepatic veins, additionally on the right side the right gonadal, suprarenal, and inferior phrenic veins also drain into the IVC (see Figure 2.4). The inferior vena cava is a large, valveless, venous trunk that receives blood from the legs, the back, and the walls and contents of the abdomen and pelvis. Primary IVC tumors (leiomyosarcomas) are very rare with only one large series published in the literature.5 It is more common to see tumors invading the IVC through its tributary veins arising from separate abdominal organs. In this chapter, we will discuss the anatomy and pathology of the IVC, starting with the anatomic variants, then we will review tumoral disease affecting the IVC and finally, we will discuss some liver transplantation and interventions. Three main hepatic veins and some minor hepatic veins drain the liver and join the inferior vena cava. Etiology and Pathophysiology (Including any Special Anatomic Considerations). The hepatic segment may not be truly absent. Intravenous contrast media may be administered to confirm venous patency, presence of a stenosis, visualization of collaterals, and/or venous tumor invasion. left posterior 8 th-11 th intercostal veins; left superior phrenic vein left renal vein (occasionally) IVC (occasionally) Variant anatomy. Posterior: IVC. X-ray catheter angiography is indicated primarily for therapeutic purposes such as installing an IVC filter, taking a biopsy of an intraluminal mass, or installing a stent to treat a venous stenosis. The liver can be divided into 9 segments and the right hepatic vein drains segments VI and VII as well as parts of segments V and VIII. Learning anatomy is a massive undertaking, and we're here to help you pass with flying colours. Inferior Vena Cava Tributaries. IVC tributaries. Anatomic variants of the IVC can be seen in association with other anomalies. A mnemonic which can be used to remember these tributaries is as follows: 'I Like To Rise So High'. CT is a very useful modality to evaluate IVC anomalies because of its ability to generate volumetric data quickly for multiplanar reformation. Hepatic portal vein. The renal segment forms via anastomosis of the right supra-subcardinal and post-subcardinal veins. The other two main veins, the middle and left hepatic veins, usually drain into the inferior vena cava as a common trunk. Thrombosis of the ovarian vein can occur postpartum and can result in a pulmonary embolism (PE). Renal Veins. The superior anatomic assessment provided by MRI or MDCT of the abdomen and pelvis makes them the modalities of choice at the time of making the final diagnosis. The origin of a second, posterior left renal vein is visualized (arrowhead). The inferior vena cava (or IVC, Latin: vena cava inferior) is the largest vein in the human body. The inferior vena cava (IVC) and major tributary veins are retroperitoneal structures with unique anatomic and developmental characteristics that offer special challenges for clinical and radiologic assessment. The inferior vena cava, the largest vein in the human body, transports blood from the lower limbs, most of the back, the abdominopelvic viscera and the abdominal walls to the right atrium. Retroaortic left renal vein: A retroaortic left renal vein may be difficult to see on Doppler imaging. Tributaries. Major tributaries such as the renal and adrenal veins have been studied extensively; however, tributaries of the infra-renal segment of the inferior vena cava (IVC) have not been given much attention. Because MRI does not expose the patient to ionizing radiation, it is possible to acquire multiple series of images postcontrast injection, including axial, coronal, and sagittal planes with different timing for more homogeneous luminal enhancement. 3 Lateral Veins-Rt suprarenal (adrenal) vein-Rt and LFT renal veins-Rt testicular vein. Primary adrenocortical carcinoma is a rare adrenal tumor that invades the IVC. Knowing the tributaries of the inferior vena cava can be important in the surgical field. Technique: To study the anatomy of the IVC, the CT protocol should include imaging of the chest, abdomen, and pelvis with the use of an intravenous iodinated contrast agent. It passes posterior to the diaphragmatic crura, enters the thorax as the azygos vein, and then joins the superior vena cava at the azygos arch. Hepatic portal system. In more complex IVC anomalies, such as duplication of IVC with retroaortic right renal vein and hemiazygos continuation of the IVC or complete absence of the IVC, ultrasonography may be unable to fully delineate all venous connections and CT or MRI may be required. In 63% of cases betwe … In human cardiovascular system: Inferior vena cava and its tributaries. Spell. It runs along the right side of the vertebral column with the aorta lying on the left. Knowledge of the IVC embryogenesis is necessary for a better understanding of the IVC anatomic aberrations. Obtain a complete anatomic assessment with CT or MRI of the relevant location (i.e., chest, abdomen, and/or pelvis). Inferior Vena Cava Tributaries. This results in venous hypertension, which can rupture thin-walled veins and results in haematuria and left flank pain. Copyright © Some lumbar veins empty into the IVC as well as into the ascending lumbar veins described in table 20.11. The right gonadal vein (ovarian in females and testicular in males) joins the inferior vena cava just inferior to the level of the left renal vein at an acute angle. Treatment involves anticoagulation and thrombolytic therapy and may involve liver transplantation if the liver disease progresses to decompensated cirrhosis. We recommend postcontrast imaging using a 3D T1-weighted gradient sequence (e.g., LAVA, THRIVE, or VIBE). Dimitrios Mytilinaios MD, PhD Renal vein thrombosis is usually asymptomatic but may present with flank pain and haematuria (blood in the urine). Both types can cause obstruction of the IVC and consequently, can cause venous congestion of the abdominopelvic organs and lower extremities. The inferior vena cava is a large, valveless, venous trunk that receives blood from the legs, the back, and the walls and contents of the abdomen and pelvis. Read more. 3 abdominal wall tributaries: inferior phrenic vein and third and fourth lumbar veins. The IVC is formed from the two common iliac veins at the L5 vertebral level. Budd-Chiari Syndrome is an uncommon condition that occurs when there is occlusion of one or more of the hepatic veins. The compression performed during a standard abdominal ultrasonographic examination may also cause collapse of some veins, making the anatomic assessment even more limited. Multidetector row CT (i.e., MDCT) has become the modality of choice for IVC assessment. This article will discuss the anatomy of these tributaries in detail, followed by any relevant clinical notes. The IVC extends from the confluence of the common iliac veins at the level of L5 vertebral body, to the right atrium of the heart in right prevertebral location, next to the abdominal aorta and is surrounded by a rich network of lymphatic vessels (Fig. The portal vein gets the subsequent tributaries: Splenic vein, a bigger formative tributary. In duplicated IVC, two vertical venous vascular structures can be seen adjacent to and paralleling the abdominal aorta. It is partially covered anteriorly by the peritoneal membrane. In the thorax, the hemiazygos vein may have any of these different drainage pathways: (1) it crosses posterior to the aorta at about T8 to T9 to join the rudimentary azygos vein; (2) it joins a persistent left SVC and drains into the coronary vein; (3) an accessory hemiazygos continues to join the left brachiocephalic vein. A circumcaval ureter is also typically not seen on ultrasound images unless there is hydroureter. Knowledge of the IVC embryogenesis is necessary for a better understanding of the IVC anatomic aberrations. C, Axial oblique MIP shows both renal veins (R) surrounding the aorta. 80-90% of the time, thrombosis occurs in the right ovarian vein. The IVC lies between the liver and the diaphragm and cephalad courses medially to … On the right, the gonadal veins and suprarenal veins drain into the inferior vena cava directly. The right renal artery crosses abnormally anterior to the IVC (Fig. Terms in this set (16) Inferior Vena Cava. It is formed near the anteroinferior aspect of the liver and enters the inferior vena cava near the upper border of the caudate lobe. Tributaries of the inferior vena cava: want to learn more about it? It is formed by the union of the common iliac veins at the level of the body of L5. The gonadal veins drain into the ipsilateral renal veins. 2. Phrenic Renal Internal Iliac. 2021 Duplicated IVC occurs in 0.2% to 3%, left IVC in 0.2% to 0.5%, azygos continuation of the IVC in 0.6%, circumaortic left renal vein in 8.7%, retroaortic left renal vein in 2.1%. One could see a renal vein crossing behind the abdominal aorta to join the IVC. There are parietal and visceral tributaries of the inferior vena cava. If CT is begun at the traditional portal venous phase (65 to 70 sec delay), the infrarenal IVC may have poor luminal enhancement owing to the relatively longer delay necessary for the venous return from the pelvis and inferior extremities to the IVC. The left IVC joins the left renal vein which then crosses posterior to the aorta to join the right IVC. This fat should not be considered pathologic and should not generate any further work-up studies. If the entire IVC is absent, the anterior paravertebral collateral vessels convey the blood return to the azygos and hemiazygos veins. Inform the patient and other physicians of the presence and kind of anatomic variant. This technique does not require the intravenous administration of gadolinium-chelate contrast agents. The tributaries of the inferior vena cava differ from the branches of the aorta in two respects. It then joins the superior vena cava at its normal location in the right paratracheal space. It receives tributaries from: Common iliac veins – formed by the external and internal iliac veins. The inferior vena cava (IVC) drains venous blood from the lower trunk, abdomen,pelvis and lower limbs to the right atrium of the heart. Hepatic portal system. The very first and 2nd lumbar veins finish in the ascending lumbar vein. The results of the anatomical study of the inferior vena cava (IVC) and its tributaries on 27 fresh cadavers were analysed. B, Sagittal reformat of the same study shows IVC segments with different luminal enhancement due to the normally observed different timing of the contrast return. At the level of the renal veins, the second lumbar vein usually joins the inferior vena cava but it may occasionally drain into the third lumbar vein or the ascending lumbar vein. Cystic Gastric Splenic. Primary IVC tumors (leiomyosarcomas) are very rare with only one large series published in the literature. Leiomyosarcomas of the IVC arise from the smooth muscle cells in the vessel wall. Think of the IVC wanting to rise high up to the heart. The most common IVC anomalies are: (1) left IVC, (2) duplicated IVC, (3) azygos continuation of IVC, (4) circumaortic left renal vein, (5) retroaortic left renal vein, (6) circumcaval or retrocaval ureter, (7) duplicated right renal vein, (8) absence of infrarenal or entire IVC, (9) duplicated IVC with retroaortic right renal vein and hemiazygos continuation of the IVC, and (10) duplication of IVC with retroaortic left renal vein and azygos continuation of the IVC. In each condition, there are documented variations in the course and tributaries of the IVC. Here, they are connected by the ascending lumbar vein, which runs anterior to the transverse processes of the lumbar vertebrae. Duplicated right renal vein: There is presence of two right renal veins, one anterior and one posterior, usually at the same level. Are you ready to learn? Multiplanar images (axial, coronal, sagittal, and oblique) better demonstrate the extent of IVC anomalies and their relationship with other anatomic structures. Palpable, painful mass could be the presentation for some tumors (i.e., renal cell carcinoma or large retroperitoneal sarcomas). The inferior vena cava and its tributaries drain blood from the feet, legs, thighs, pelvis and abdomen and deliver this blood to the heart. and grab your free ultimate anatomy study guide! 2. Version 2.69 36790-4MRA Inferior vena cava + tributariesActive Term Description This study is used to image the inferior vena cava (IVC) and its tributaries. Last reviewed: December 21, 2020 The diameter of the main hepatic veins on average 12.3 mm, and back — 4.8 mm. Lumbales, only 3-4) are formed in the walls of the abdominal cavity. Similar anatomic detail can be seen on MRI as is seen on CT. Steady-state free precession (SSFP; also termed, “Black blood” MRI pulse sequences, in which the vessel lumen is dark secondary to the washout phenomenon (also termed, Reporting: Information for the Referring Physician. FIGURE 110-4 Circumaortic left renal vein. Hepatocellular carcinoma (HCC) frequently invades the portal vein but also on rare occasions can invade the IVC through the hepatic veins. It is partially covered anteriorly by the peritoneal membrane. Early in embryogenesis, there are two renal veins for each kidney: ventral and dorsal. The origin and anatomical course of the azygos vein are quite variable. A, Contrast-enhanced CT axial images show infrarenal IVC (I) and a smaller duplicated left IVC (arrow) that arises from the left iliac vein. 1. The middle hepatic vein usually drains segments IV, V and VIII, whilst the left hepatic vein drains segments II and III as well as segment IV on occasion. Note that some professors will want you to know at which vertebral level the … The emergence of CT and MRI for vascular imaging has facilitated the transitioning of x-ray catheter angiography from merely a diagnostic tool to a viable less invasive percutaneous therapeutic replacement for complex open surgical interventions. The suprarenal IVC, moreover, may show heterogeneous enhancement because of mixing of the contrast bolus returning from the renal veins. Right adrenocortical carcinomas directly invade the IVC through the adrenal veins. 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