It is formed by the union of the common iliac veins at the level of the body of L5. It is formed near the anteroinferior aspect of the liver and enters the inferior vena cava near the upper border of the caudate lobe. The tributaries of the inferior vena cava differ from the branches of the aorta in two respects. Branches of abdominal aorta: a) lumbar arteries b) inferior epigastric arteries c) middle adrenal arteries d) superior diaphragmatic arteries a) lumbar arteries b) inferior epigastric arteries c) middle The best imaging consideration would be CT with multiplanar reformation. 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. C, Axial oblique MIP shows both renal veins (R) surrounding the aorta. 3. Only gold members can continue reading. It is always important to keep in mind that MRI examinations do not expose the patient to ionizing radiation. 3 formative veins: 2 common iliac veins and the median sacral vein. The left IVC joins the left renal vein which then crosses posterior to the aorta to join the right IVC. It runs along the right side of the vertebral column with the aorta lying on the left. Terms in this set (16) Inferior Vena Cava. Some lumbar veins empty into the IVC as well as into the ascending lumbar veins described in table 20.11. They can arise in any segment of the IVC and can extend intraluminally to the right atrium of the heart. 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. The right renal artery crosses abnormally anterior to the IVC (Fig. Superior mesenteric vein, a smaller formative tributary. Close to the inferior vena cava, it is found anterior to the aorta and inferior to the superior mesenteric artery. The right IVC joins the right renal vein, which crosses posterior to the aorta to drain in the left IVC. Circumaortic left renal vein: A circumaortic left renal vein may be difficult to see on Doppler imaging because the two veins do not join the IVC at the same level. At the level of the T12, the right suprarenal vein drains into the inferior vena cava. Occasionally, a palpable mass may be felt in the right iliac fossa. This article will discuss the anatomy of these tributaries in detail, followed by any relevant clinical notes. The specific levels of the tributaries are as follows: Because the IVC is not centrally located, there are some asymmetries in drainage patterns. This results in venous hypertension, which can rupture thin-walled veins and results in haematuria and left flank pain. Obstruction of the superior vena cava (SVC) or inferior vena cava (IVC) is most commonly an acquired condition, typically caused by malignancy, benign conditions such as mediastinal fibrosis, and iatrogenic causes such as venous catheterization. Multiple other retroperitoneal tumors can compress and invade the IVC, including lymphomas, metastasis of gonadal or uterine tumors, pheochromocytomas, and other retroperitoneal sarcomas. The latter may join the left common iliac vein. Deviations in the complex embryogenesis of the IVC may result in an overall 4% of anatomic variants in the general population. The IVC is composed of four segments which form during the 6 to 8 weeks postconception. IVC tributaries. It drains directly into the right atrium. The very first and 2nd lumbar veins finish in the ascending lumbar vein. MRI assessment of the IVC has also been improved with recent advances. Primary adrenocortical carcinoma is a rare adrenal tumor that invades the IVC. There may be a significant size difference between the two vessels. 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. The IVC has: 3 anterior visceral tributaries (three hepatic) 3 lateral visceral tributaries (suprarenal, renal, gonadal) 5 lateral abdominal wall tributaries (inferior phrenic and four lumbar) With partial or complete absence of the IVC, large gonadal and parauterine veins can be seen. Our products are designed to not only help you pass exams, but retain your medical knowledge for life. • Anatomy/CV. The tributaries of the IVC correspond to the branches of the abdominal aorta. 3 abdominal wall tributaries: inferior phrenic vein and third and fourth lumbar veins. With retroaortic left renal vein, an increased incidence of testicular varicoceles has been reported, presumably due to compression of the left renal vein by the abdominal aorta. FIGURE 110-2 IVC duplication (infrarenal). Our engaging videos, interactive quizzes, in-depth articles and HD atlas are here to get you top results faster. I Like To Rise So High Iliac Lumbar Testicular Renal Suprarenal Hepatic vein. In the tributaries, but can develop secondary to an obstructive process that reduces IVC flow What syndrome is a common cause of IVC thrombus? The inferior vena cava is formed by the confluence of the two common iliac veins at the L5 vertebral level. Hepatic veins. The right IVC (I) continues through the azygos vein (A) above the level of the renal veins. Therefore, this syndrome can result in liver disease if not treated. The fast scanning speeds that they can obtain has reduced motion artifacts to a minimum and enabled quick extended coverages of body anatomy, notably for rapid assessment of the heart, IVC, and pelvic veins. 3 Lateral visceral tributaries: right suprarenal vein, renal veins, and right testicular/ovarian vein. In each condition, there are documented variations in the course and tributaries of the IVC. Recommendations for clinicians are. The diameter of the main hepatic veins on average 12.3 mm, and back — 4.8 mm. The circumaortic venous ring and retroaortic left renal vein are related to aberrant development of the renal segment. Budd-Chiari in the hepatic veins extending into the IVC. 20.36): 1. The inferior vena cava (IVC) drains venous blood from the lower trunk, abdomen,pelvis and lower limbs to the right atrium of the heart. Parietal inflows are formed in the walls of the abdominal cavity and pelvic cavity. X-ray catheter angiography studies provide limited anatomic information. IVC duplication (infrarenal). Ultrasound imaging with color flow Doppler imaging can be diagnostic for a variety of IVC anomalies. The IVC is formed by the joining of the left and right common iliac veins and brings collected blood into the right atrium of the heart. Duplicated right renal vein: There is presence of two right renal veins, one anterior and one posterior, usually at the same level. Duplicated IVC: There are two IVCs below the level of the renal veins—each connected to the ipsilateral common iliac vein. Accurate knowledge of the anatomy of these veins is necessary for improved efficacy of surgical interventions in the retroperitoneum. Azygos-hemiazygos continuation of the IVC with duplication of the infrarenal IVC. Duplication of IVC with retroaortic right renal vein and hemiazygos continuation of the IVC: There are two IVCs below the level of the renal veins. Multiplanar images (axial, coronal, sagittal, and oblique) better demonstrate the extent of IVC anomalies and their relationship with other anatomic structures. Because the left adrenal veins drain to the left renal vein, left adrenal tumors reach the IVC through this pathway. CT is a very useful modality to evaluate IVC anomalies because of its ability to generate volumetric data quickly for multiplanar reformation. FIGURE 110-1 Normal IVC. Another advantage of modern advanced MDCT scanners is their isotropic voxel resolution, allowing improved multiplanar reformation of image data (i.e., axial, coronal, sagittal, or oblique) with high spatial resolution, providing excellent anatomic assessment of complex anatomic relationships that can often be the case when evaluating vascular anatomy of abdominal organs. FIGURE 110-4 Circumaortic left renal vein. “Black blood” MRI pulse sequences, in which the vessel lumen is dark secondary to the washout phenomenon (also termed flow void) associated with moving spins (i.e., flowing blood that washes out of the imaging slice prior to sampling of the echo). Three main hepatic veins and some minor hepatic veins drain the liver and join the inferior vena cava. The patients typically present lower extremity edema and subcutaneous collateral veins in the abdominal wall. Anatomic variants of the IVC can be seen in association with other anomalies. At this level, a fat pad (continuous with the retroperitoneal fat) can be seen in many normal patients in an inferomedial location, sometimes bulging into the lumen of the IVC. The first main vein is the longest, most variable vein and is referred to as the right hepatic vein. Anatomical variations or obstruction of the IVC can make these procedures difficult. The first step in this complex process is the formation of the posterior supracardinal and more anterior subcardinal veins. The detection of anatomic variants in the renal veins is particularly important at the time of surgical planning for kidney donation. 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%. Patients with IVC anatomic aberrations are most commonly asymptomatic and the anomaly is discovered fortuitously during an imaging study ordered to assess other problems. The left inferior phrenic vein drains higher than its right counterpart and is found superior to the oesophageal opening in the diaphragm. Tributaries. Many one-way venous valves help to move blood through the veins of the lower extremities against the pull of gravity. T8: paired inferi… In duplicated IVC, two vertical venous vascular structures can be seen adjacent to and paralleling the abdominal aorta. FIGURE 110-3 Azygos-hemiazygos continuation of the IVC with duplication of the infrarenal IVC. Similar anatomic detail can be seen on MRI as is seen on CT. Steady-state free precession (SSFP; also termed b-FFE, Philips Medical Systems; FIESTA, General Electric Healthcare; True-FISP, Siemens Medical Solutions) pulse sequences are “bright blood” techniques that are particularly good for illustrating abdominal veins. Knowledge of the IVC embryogenesis is necessary for a better understanding of the IVC anatomic aberrations. It is recommended to ensure that there is at least a 2-minute delay between intravenous contrast administration and CT scanning because this will improve the likelihood for homogeneous enhancement of the IVC. The right renal vein is 2.5 cm long and is found posterior to the second part of the duodenum. 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. 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 retroperitoneal space where the IVC is located can communicate with the perirenal spaces and the anterior and posterior interfascial spaces.1. With the absence of infrarenal IVC or entire IVC, patients may present with venous insufficiency of the lower extremities or idiopathic deep venous thrombosis. Are you ready to learn? There are usually five pairs of lumbar veins. 110-1). It is formed by the union of the common iliac veins at the level of the body of L5. Note that some professors will want you to know at which vertebral level the … Tributaries of Inferior Vena Cava. As it ascends the abdominal cavity, the IVC picks up blood from numerous tributaries in the order listed here (fig. 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. Phrenic. Retroaortic left renal vein: The renal vein crosses posterior to the aorta to join the IVC. I Like To Rise So High Iliac Lumbar Testicular Renal Suprarenal Hepatic vein. The inferior vena cava (IVC) is formed by the union of the right and left common iliac veins at the level of vertebra L5. Symptoms include right lower quadrant pain and a fever. The hepatic and right adrenal veins drain directly into the right atrium. 3 Anterior hepatic veins -RHV-MHV-LHV. 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. Genetic factors may play a role in IVC anomalies because having a first-degree relative with an IVC anatomic anomaly is considered a risk factor. Gadolinium-enhanced MRI is arguably the most reliable method to assess vascular patency. The left suprarenal vein and left gonadal veins drain into th… Approximately 5% of patients younger than 30 years with idiopathic deep venous thrombosis show IVC absence on CT. 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. The IVC has a retroperitoneal course within the abdominal cavity. 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. Thrombosis can also occur in the renal veins and is most common in patients with nephrotic syndrome, a kidney disorder characterised by proteinuria (protein in the urine), oedema and hypercholesterolemia. It opens into its right anterolateral aspect and is usually double in its course. 2. It is located at the posterior abdominal wall on the right side of the aorta. Like with the ovarian vein, it can also cause a PE, so prophylaxis with anticoagulants is usually carried out. The gonadal veins and suprarenal veins drain into the IVC on the right side, but into the renal vein on the left side, which in turn drains into the IVC. If the tumor obstructs the hepatic segment of the IVC, it may manifest as, Clinical Techniques of Cardiac Magnetic Resonance Imaging: Morphology, Perfusion, and Viability, Basic Three-Dimensional Postprocessing in Computed Tomographic and Magnetic Resonance Angiography, Indications and Patient Selection in Obstructive Coronary Disease, Advanced Three-Dimensional Postprocessing in Computed Tomographic and Magnetic Resonance Angiography, Radiopharmaceuticals and Radiation Dose Considerations in Cardiac Positron Emission Tomography and PET/CT, Renal Arteries: Computed Tomographic and Magnetic Resonance Angiography, Methods for Cardiac Magnetic Resonance Imaging, CARDIOVASCULAR IMAGING CARDIOVASCULAR IMAGING. Log In or, Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), on Inferior Vena Cava and Its Main Tributaries. During its course, it receives many veins referred to as tributaries of the inferior vena cava. If the tumor obstructs the hepatic segment of the IVC, it may manifest as Budd-Chiari syndrome with abdominal pain, hepatomegaly, and ascites due to obstruction of the hepatic veins. MRI risks are related to those associated with the magnetic field but also to that of intravenous contrast agent administration if performed. 110-1). The origin of a second, posterior left renal vein is visualized (arrowhead). It is partially covered anteriorly by the peritoneal membrane. A, CECT of the abdomen shows a left renal vein crossing anterior to the aorta (arrow). The IVC gets the following tributaries: 1. Gravity. The image also shows a large hemiazygos vein (arrow) that arises from the left renal vein as continuation of the left IVC. It is retroperitoneal and lies immediately to the right of the aorta. Plain radiographs of the abdomen and pelvis have no role in the anatomic assessment of the IVC because they are unable to differentiate the veins from other retroperitoneal soft tissues. 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. ... Tributaries to the inferior vena cava include the following veins: common iliac veins, lumbar veins, right testicular or ovarian vein, renal veins, right suprarenal vein, inferior phrenic veins, and ; hepatic veins. Tributaries. Splenic . Hepatic portal vein. 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. The diameter of the main hepatic veins on average 12.3 mm, and back — 4.8 mm. It is partially covered anteriorly by the peritoneal membrane. The inferior vena cava is ne of two great veins, known as vena cavae, in the general or systemic circulatory system of the body, the other being the superior vena cava.The inferior vena cava is the widest vein in the body and one of the longest; it conveys most of the blood from the body below the diaphragm to the right atrium of the heart. Hepatic portal system. This causes hypercoagulability thus increasing the risk of thrombus formation. They drain the lower limbs and gluteal region. Both types can cause obstruction of the IVC and consequently, can cause venous congestion of the abdominopelvic organs and lower extremities. The advantages of these two modalities are among the following: There are some risks involved in the use of MDCT, including the ones related to ionizing radiation and the use of intravenous contrast media. 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