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Fulltext Large adrenocortical carcinoma extending into the inferior vena cava and right atrium

Hisham AN, Sarojah A, Zanariah H

Asian J Surg, 2003 Jan;26(1):40-2.
PMID: 12527494

A case of large adrenocortical carcinoma extending into the inferior vena cava and right atrium is reported. Computed tomography showed a large mass displacing the left kidney inferiorly with an intravascular tumour thrombus extending into the inferior vena cava and right atrium. Radical surgery under hypothermia and cardiopulmonary bypass was performed and the tumour mass, together with the tumour thrombus, was successfully removed. The presence of intravascular tumour extension alone should not be a contraindication to radical surgical therapy, as it is the best hope for prolonged survival.

Matched MeSH terms: Vena Cava, Inferior/pathology*
Fulltext Sporadic renal angiomyolipoma with IVC extension

Priyanka G, Poh EY, Yeong SS

Med J Malaysia, 2013 Dec;68(6):473-4.
PMID: 24632917

Angiomyolipomas (AML) are the most common mesenchymal renal neoplasms arising in the cortex or medulla. Intra-renal and retroperitoneal hemorrhages have been frequently reported. AML can exceptionally involve the renal vein and inferior vena cava. We report a case with extension into the inferior vena cava.

Matched MeSH terms: Vena Cava, Inferior
Fulltext The value of pre-operative embolisation in primary inferior vena cava paraganglioma

Zaki FM, Osman SS, Abdul Manaf Z, Mahadevan J, Yahya M

Malays J Med Sci, 2011 Apr;18(2):70-3.
PMID: 22135590

We report a case of a 13-year-old boy who complained of progressive abdominal distension and symptoms of anaemia. Radiological investigations revealed that the child had a hypervascular tumour of the inferior vena cava (IVC). Unfortunately, the child presented with acute lower gastrointestinal bleed soon after the investigation. He underwent an urgent pre-operative embolisation, aimed to reduce the tumour vascularity. A total resection of the tumour, right nephrectomy, and partial duodenal resection were done within 24 hours post-embolisation. The child was stable postoperatively. The histopathological examination revealed chromogranin-positive paraganglioma originating from the IVC. We highlight the radiological findings of rare primary IVC paraganglioma and the role of embolisation prior to surgical removal of the tumour.

Matched MeSH terms: Vena Cava, Inferior
Fulltext Retrocaval Ureter: Report of 2 Different Clinical Spectrums

Khairul Asri, Malinda, Tee, S.C., Sundram, Woo, S.

Malaysian Journal of Medicine and Health Sciences, 2014;10(1):39-42.
MyJurnal

etrocaval ureter is a relatively rare anomaly where ureteric obstruction may occur as a result of ureter passes behind the inferior vena cava (IVC), hence, compressing it between the IVC and the vertebrae. We report 2 cases of retrocaval ureter with different presentations. One patient was managed surgically with minimally invasive approach and the other was managed conservatively.

Matched MeSH terms: Vena Cava, Inferior
Robot-assisted Cavectomy Versus Thrombectomy for Level II Inferior Vena Cava Thrombus: Decision-making Scheme and Multi-institutional Analysis

Shi T, Huang Q, Liu K, Du S, Fan Y, Yang L, et al.

Eur Urol, 2020 10;78(4):592-602.
PMID: 32305170 DOI: 10.1016/j.eururo.2020.03.020

BACKGROUND: Robot-assisted thrombectomy (RAT) for inferior vena cava (IVC) thrombus (RAT-IVCT) is being increasingly reported. However, the techniques and indications for robot-assisted cavectomy (RAC) for IVC thrombus are not well described.
OBJECTIVE: To develop a decision-making program and analyze multi-institutional outcomes of RAC-IVCT versus RAT-IVCT.
DESIGN, SETTING, AND PARTICIPANTS: Ninety patients with renal cell carcinoma (RCC) with level II IVCT were included from eight Chinese urological centers, and underwent RAC-IVCT (30 patients) or RAT-IVCT (60 patients) from June 2013 to January 2019.
SURGICAL PROCEDURE: The surgical strategy was based on IVCT imaging characteristics. RAT-IVCT was performed with standardized cavotomy, thrombectomy, and IVC reconstruction. RAC-IVCT was mainly performed in patients with extensive IVC wall invasion when the collateral blood vessels were well-established. For right-sided RCC, the IVC from the infrarenal vein to the infrahepatic veins was stapled. For left-sided RCC, the IVC from the suprarenal vein to the infrahepatic veins was removed and caudal IVC reconstruction was performed to ensure the right renal vein returned through the IVC collaterals.
MEASUREMENTS: Clinicopathological, operative, and survival outcomes were collected and analyzed.
RESULTS AND LIMITATIONS: All procedures were successfully performed without open conversion. The median operation time (268 vs 190 min) and estimated blood loss (1500 vs 400 ml) were significantly greater for RAC-IVCT versus RAT-IVCT (both p < 0.001). IVC invasion was a risk factor for progression-free and overall survival at midterm follow-up. Large-volume and long-term follow-up studies are needed.
CONCLUSIONS: RAC-IVCT or RAT-IVCT represents an alternative minimally invasive approach for selected RCC patients with level II IVCT. Selection of RAC-IVCT or RAT-IVCT is mainly based on preoperative IVCT imaging characteristics, including the presence of IVC wall invasion, the affected kidney, and establishment of the collateral circulation.
PATIENT SUMMARY: In this study we found that robotic surgeries for level II inferior vena cava thrombus were feasible and safe. Preoperative imaging played an important role in establishing an appropriate surgical plan.

Matched MeSH terms: Vena Cava, Inferior/surgery*
Fulltext Amebic Liver abscess Complicated by Inferior Vena Cava Thrombosis: A Case Report

Ray S, Khanra D, Saha M, Talukdar A

Med J Malaysia, 2012 Oct;67(5):524-5.
PMID: 23770872

Amebic liver abscess is the most common extraintestinal manifestation of infection with Entamoeba histolytica. It is a common disease, especially in endemic areas, but it is a rare cause of inferior vena cava (IVC) obstruction, with only a few cases appearing in the literature. The authors describe a case of amebic liver abscess in a patient who developed a rare vascular complication of inferior vena cava thrombosis. The case responded to conservative treatment and radiological intervention.

Matched MeSH terms: Vena Cava, Inferior*
Fulltext Case report of a difficult venous access: retroperitoneal approach of inserting an improved non-heparinised port for long-term use

Chan KY, Teoh CM, Sukumar N

Med J Malaysia, 2005 Mar;60(1):94-6.
PMID: 16250289

This is a case report of a patient with difficult venous access following thrombosis of major superficial and deep veins of the limbs as documented by ultrasound doppler and venography. The insertion of a few central ports were infected and the vein thrombosed. Venography revealed that central venous access was no longer feasible. The previous laparotomies had resulted in dense intra-peritoneal adhesions, and rendered further laparotomy virtually impossible. The patient had occasional adhesion colics, vomiting and hypoglycemic episodes. A rarely performed retro-peritoneal approach of inserting an improved non-heparinised port proved to be effective for long-term management of this patient. The surgical approach and the selected port are discussed.

Matched MeSH terms: Vena Cava, Inferior*
Persistent valve of systemic venous sinus: a cause of neonatal cyanosis

Qureshi AU, Latiff HA, Sivalingam S

Cardiol Young, 2014 Aug;24(4):756-9.
PMID: 24016801 DOI: 10.1017/S1047951113001200

Incomplete involution of valve of systemic venous sinus can present across a spectrum of anatomical lesions ranging from eustachian valve to division of right atrium (cor triatriatum dexter) with overlapping features. We present the case of a neonate presenting with cyanosis, having persistent valve of systemic venous sinus with anatomical details of the redundant tissue in right atrium suggesting an intermediate form between Chiari network and division of right atrium.

Matched MeSH terms: Vena Cava, Inferior/abnormalities; Vena Cava, Inferior/ultrasonography*
NEPHRON-SPARING SURGERY IN PATIENTS WITH RENAL CELL CARCINOMA EXTENDING TO THE MAIN RENAL VEIN: INTRARENAL AND EXTRARENAL THROMBECTOMY

Shchukin D, Lisova G, Khareba G, Polyakov M, Antonyan I, Kopytsya M, et al.

Georgian Med News, 2019 Dec.
PMID: 32011290

In most cases RCC with venous extension is an indication for radical nephrectomy. However, in patients with imperative indications for nephron-sparing surgery a kidney resection with thrombectomy in rare situations is possible. We present a surgical technique for nephron-sparing surgery in patients with tumor spreading into the main renal vein. From 2007 to 2019 seven partial nephrectomies with removal of the tumor thrombus from the main renal vein were performed. Absolute imperative indications were recorded in 6 (85.7%) patients (4 with solitary kidney, 2 with bilateral tumors). Dimensions of renal tumor averaged 6.5±2.3 cm. Intravenous part of the tumor penetrated the initial portion of the renal vein in 3 cases, main trunk of the renal vein in 3 cases, and cavarenal portion of the IVC in 1 case. The average length of the tumor thrombus was 24.0±6.9 mm, and the width was 9.3±4.8 mm. Tumor thrombi were classified as intrarenal and extrarenal. In accordance with this principle surgical procedures were divided into partial nephrectomy with intrarenal (3/42.9%) and extrarenal thrombectomy (4/57.1%). Intrarenal thrombectomy was characterized by thrombus removal out of the vein lumen from the side of the kidney resection area, while extrarenal thrombectomy included additional opening the lumen of the main renal vein or inferior vena cava (IVC). In one patient hypothermic perfusion of the kidney in situ was used. In two cases the extracorporeal partial nephrectomy with kidney autotransplantation was performed. Warm ischemia time averaged 14.0 minutes. The time of ischemia during hypothermic perfusion in situ reached 76 minutes, the time of cold ischemia during extracorporeal surgery averaged 68.0 minutes. The volume of blood loss did not exceed an average of 621.4±146.8 ml. Early postoperative complications occurred in 4 (57.1%) cases (bleeding -1, ischemic stroke -1, deterioration of renal failure -2). Postoperative mortality was registered in 1 patient due to bleeding and heart failure. The follow-up period averaged 28.7±18.9 months. Distant metastases occurred in 1 (14.3%) patient after 16 months. Local tumor recurrence in the remnant kidney after nephron-sparing surgery was not detected in any case. Nephron-sparing surgery may be used to treat patients with kidney tumors and neoplastic venous thrombosis. However, this complex surgical approach requires further technical improvement.

Matched MeSH terms: Vena Cava, Inferior
Fulltext Behcet's syndrome with sagittal sinus and inferior vena caval thrombophlebitis

Segasothy M

Med J Malaysia, 1982 Jun;37(2):132-3.
PMID: 7132832

This report describes a case of Behcet's syndrome in which there was involvement of both the intracranial and systemic veins. The pathogenesis of Behcet's syndrome is discussed.

Matched MeSH terms: Vena Cava, Inferior*
Fulltext Radical resection of primary leiomyosarcoma of inferior vena cava

Ikhwan Sani Mohamad, Sivabalan Nadarajan, Azim Idris, Hairol Othman, Affirul Chairil, Razman Jarmin

Malaysian Journal of Medicine and Health Sciences, 2018;14(1):61-64.
MyJurnal

Leiomyosarcoma of the Inferior Vena Cava (IVC) is a rare soft tissue tumour which accounts for only 0.5% of all soft tissue sarcomas. The patients usually presented with non specific clinical signs and often diagnosed at advanced stage. We reported a case of a 58-year-old lady who presented with right sided abdominal pain for 6 months. CT scan showed large Level 2 IVC tumour which encased the right renal vein and had no clear plane of demarcation with the caudate lobe of the liver. She underwent radical resection of the IVC tumour with the right kidney removed en bloc. Vascular reconstruction was not performed as established collateral veins present. She was nursed in Intensive Care Unit for 2 days and discharged well at day 5 post operatively. Histopathological examination results revealed leiomyosarcoma of IVC.

Matched MeSH terms: Vena Cava, Inferior
Fulltext Ultrasonography measurement of inferior vena cava diameter of blood donors as predictors for early blood loss in tertiary hospital northeastern, Malaysia

Shaik Farid AW, Mohd Hashairi F, Nik Hisamuddin NA, Chew KS, Rashidi A

Med J Malaysia, 2013 Dec;68(6):465-8.
PMID: 24632914 MyJurnal

According to the class of hypovolaemic shock, a blood loss less than 750 ml is not associated with the physiological changes. As a result it may cause a delay in fluid resuscitation. We postulate inferior vena cava (IVC) diameter reduction in inspiration and expiration may resemble the significant volume of blood loss in a healthy adult. We conducted a study to examine the changes of the IVC diameter pre and post blood donation.The inferior vena cava diameter during inspiration (IVCi) and expiration (IVCe) were measured using ultrasound (GE HEALTH) in supine position before and after blood donation of 450 ml. Paired t-test and Wilcoxin rank test were used to analyse the data. Forty two blood donors enrolled during the study period. The mean age of blood donors was 32.3 +/- 8.9 and mainly male blood donors. The mean IVCe of pre and post blood donation was 18.5 +/- 6.2 mm (95%CI 18.23, 18.74) and 16.6 +/- 6.6 mm (95%CI 16.35, 16.76) respectively. Meanwhile, the mean IVCi of pre and post blood donation was 17.1 +/- 8.6 mm (95%CI 16.89,17.30) and 15.6 +/- 6.6 mm (95%CI 15.43,15.81) respectively. The mean difference of IVCe pre and post blood donation was 1.9 +/- 0.5 mm (95%CI 1.75, 2.13) (p<0.001). In contrast, the mean difference of IVCi pre and post blood donation was 1.5 +/- 0.5 mm (95%CI 1.34, 1.68) (p<0.001). As a conclusion, the measurement of IVC diameter by ultrasound can predict the volume of blood loss in simulated type 1 hypovolaemia patient.

Matched MeSH terms: Vena Cava, Inferior
Fulltext Growth of Hepatocellular Carcinoma into the Right Atrium with Associated Pulmonary Tumour Emboli

Amran, A.R., Ranganathan, S.

International Medical Journal Malaysia, 2006;5(1):1-5.
MyJurnal

Hepatocellular carcinoma (HCC) presenting with right atrial metastases and pulmonary tumour embolism is rare . Intracavitary cardiac metastasis is uncommon and metastasis to the right atrium is even less common. The majority of such cases are believed to be due to advanced HCC such as Stage III or IV, in which the progression rate is high, and in infiltrative HCC it tends to be associated with vascular invasion. The diagnosis of pulmonary intravascular tumour emboli is difficult to establish both clinically and with conventional radiographic studies. We report a case hepatocellular carcinoma associated with tumour thrombus in the inferior vena cava (IVC), right atrium and pulmonary tumour embolism detected with multidetector helical computerized tomography (MDHCT).

Matched MeSH terms: Vena Cava, Inferior
Fulltext Metastatic Adenocarcinoma Presenting as Extensive Cavoatrial Tumor Thrombus

Johari B, Abdul Aziz YF, Krishnasamy S, Looi LM, Hashim SA, Raja Mokhtar RA

Iran J Radiol, 2015 Apr;12(2):e11197.
PMID: 26060549 DOI: 10.5812/iranjradiol.11197

The presence of tumor thrombus in the right atrium is frequently the result of direct intraluminal extension of infra-diaphragmatic malignancy into the inferior vena cava (IVC) or supradiaphragmatic carcinoma into the superior vena cava (SVC). Right atrial tumor thrombus with extension into both SVC and IVC has not been reported in the literature. We present a patient who presented with symptoms of right atrial and SVC obstruction. Imaging revealed presence of a thrombus in the right atrium, extending to the SVC and IVC, with the additional findings of a left adrenal mass and multiple liver lesions. The histopathological examination of the right atrial mass revealed metastatic adenocarcinoma cells. The patient was given a presumptive diagnosis of metastatic adenocarcinoma, most likely adrenal in origin, with multiple hepatic lesions suspicious for metastasis. The clinical outcome of the patient was not favorable; the patient succumbed before the adrenal mass could be confirmed to be the primary tumor. This case highlights that in patients manifesting with extensive cavoatrial thrombus as, the existence of primary carcinoma should be considered especially in the adrenal cortex or in the lung.

Matched MeSH terms: Vena Cava, Inferior
Fulltext Extra-adrenal paraganglioma: presentation in three uncommon locations

Mun KS, Pailoor J, Chan KS, Pillay B

Malays J Pathol, 2009 Jun;31(1):57-61.
PMID: 19694315 MyJurnal

Extra-adrenal paragangliomata are uncommon entities. They can be classified into four basic groups according to their anatomical sites, i.e. branchiomeric, intravagal, aorticosympathetic and visceral autonomic. Similar tumours may arise in sites away from the usual distribution of the sympathetic and parasympathetic ganglia, e.g. orbit, nose, small intestine and even in the pancreas. We report three instructive cases of extra-adrenal paraganglioma which were found in unusual sites such as urinary bladder, thyroid gland and on the wall of the inferior vena cava.

Matched MeSH terms: Vena Cava, Inferior/metabolism; Vena Cava, Inferior/pathology*; Vena Cava, Inferior/surgery
Fulltext An uncommon and insidious presentation of renal cell carcinoma with tumor extending into the inferior vena cava and right atrium: a case report

Lu HT, Chong JL, Othman N, Vendargon S, Omar S

J Med Case Rep, 2016 May 03;10(1):109.
PMID: 27142514 DOI: 10.1186/s13256-016-0888-5

BACKGROUND: Renal cell carcinoma is a potentially lethal cancer with aggressive behavior and it tends to metastasize. Renal cell carcinoma involves the inferior vena cava in approximately 15% of cases and it rarely extends into the right atrium. A majority of renal cell carcinoma are detected as incidental findings on imaging studies obtained for unrelated reasons. At presentation, nearly 25% of patients either have distant metastases or significant local-regional disease with no symptoms that can be attributed to renal cell carcinoma.
CASE PRESENTATION: A 64-year-old Indian male with a past history of coronary artery bypass graft surgery, congestive heart failure, and diabetes mellitus complained of worsening shortness of breath for 2 weeks. Incidentally, a transthoracic echocardiography showed a "thumb-like" mass in his right atrium extending into his right ventricle through the tricuspid valve with each systole. Abdomen magnetic resonance imaging revealed a heterogenous lobulated mass in the upper and mid-pole of his right kidney with a tumor extending into his inferior vena cava and right atrium, consistent with our diagnosis of advanced renal cell carcinoma which was later confirmed by surgical excision and histology. Radical right nephrectomy, lymph nodes clearance, inferior vena cava cavatomy, and complete tumor thrombectomy were performed successfully. Perioperatively, he did not require cardiopulmonary bypass or deep hypothermic circulatory arrest. He had no recurrence during the follow-up period for more than 2 years after surgery.
CONCLUSIONS: Advanced extension of renal cell carcinoma can occur with no apparent symptoms and be detected incidentally. In rare circumstances, atypical presentation of renal cell carcinoma should be considered in a patient presenting with right atrial mass detected by echocardiography. Renal cell carcinoma with inferior vena cava and right atrium extension is a complex surgical challenge, but excellent results can be obtained with proper patient selection, meticulous surgical techniques, and close perioperative patient care.

Matched MeSH terms: Vena Cava, Inferior/surgery
Fulltext Azygos continuation of the inferior vena cava in carcinoma of oesophagus.

Mubarak, M.Y.

International Medical Journal Malaysia, 2008;7(2):57-61.
MyJurnal

The azygos system enlarges in cases of obstruction to the superior vena cava or inferior vena cava and result in increase blood flow through the system. Azygos continuation of the inferior vena cava is usually congenital and asymptomatic. The azygos vein is the sole drainage of the blood from the lower half of the body to the heart. It is crucial to identify the anomaly as it might involve in the surgical planning of tumours in the thorax or abdomen. Computed Tomography is a non-invasive technique and provide important information about the tumour and the vascular anomaly.

Matched MeSH terms: Vena Cava, Inferior
Fulltext Inferior vena cava tumour thrombectomy by novel endovascular approach

Shahril, K., Reynu, R., Kosai, N.R., Bong, J.J., Rozman, Z., Yazmin, Y., et al.

Medicine & Health, 2015;10(2):151-155.
MyJurnal

The presence of thrombus within the inferior vena cava (IVC) is often a sign of advance hepatocellular carcinoma (HCC). Various treatment methods have been described with variable and inconclusive results. Now, the advancement of endovascular approach offers new possibility as a potential treatment modality. We discuss the removal of tumour thrombus with catheter directed mechanical thrombectomy. IVC tumour secondary HCC was removed by AngioJet® rheolytic system (Possis Medical, Minneapolis, MN, USA) with good result. Further work should be encouraged to explore the prospect of this technique with other treatment modalities.

Matched MeSH terms: Vena Cava, Inferior
Fulltext Ultrasonographic assessment of inferior vena cava/abdominal aorta diameter index: a new approach of assessing hypovolemic shock class 1

Rahman NH, Ahmad R, Kareem MM, Mohammed MI

Int J Emerg Med, 2016 Dec;9(1):8.
PMID: 26894896 DOI: 10.1186/s12245-016-0101-z

We designed this study to expand the usage of ultrasound to detect early occurrence of hypovolemia. We explore the potential use of inferior vena cava (IVC) and abdominal aorta (AA) diameter index (IVC:AA) measured ultrasonographically to detect class 1 hypovolemic shock with blood loss less than 15%.ᅟ

Matched MeSH terms: Vena Cava, Inferior
Ultrasonographic Measurements of the Liver, Gallbladder Wall Thickness, Inferior Vena Cava, Portal Vein and Pancreas in an Urban Region, Malaysia

Khammas ASA, Mahmud R

J Med Ultrasound, 2020 10 01;29(1):26-31.
PMID: 34084713 DOI: 10.4103/JMU.JMU_53_20

Background: Ultrasonographic (USG) measurements of the liver length, gallbladder wall thickness (GBWT), diameters of the inferior vena cava (IVC), portal vein (PV), and pancreas are valuable and reliable in diagnosis hepatobiliary and pancreas conditions. This study is aimed to determine the normal values of liver length, GBWT, AP diameters of the IVC and PV, AP diameter of the head and body of the pancreas.
Methods: A prospective cross-sectional study was carried out in this study. A total of the 408 participants were randomly recruited using a systematic method. According to the USG reports, the subjects who had normal USG report for liver, biliary system, and pancreas were described as normals, whereas the subjects who had hepatobiliary diseases such as fatty liver, liver cysts, hemangioma, cirrhosis, gallbladder wall thickening, acute cholecystitis, gallstones, and polyps were recorded as abnormal subjects.
Results: Of the 408 participants with a mean of 52.6 ± 8.4 years old. Of those, 294 (72.1%) participants were normal and 114 (27.9%) subjects were reported as abnormal. More than half of the study population was males, 52.9% versus 47.1% of females. There was a significant difference of liver length, head, and body of the pancreas between genders (P = 0.004, 0.002, and P < 0.001, respectively). Moreover, the pancreatic body only was significantly correlated with age (P = 0.026). There also was a significant difference of the liver length, head, and body of the pancreas between normal and abnormal subjects (P < 0.001, P = 0.007, and P < 0.001).
Conclusion: Liver length, diameter of the head, and body of the pancreas were significantly associated with gender and hepatobiliary diseases. In addition, only the diameter of the body of the pancreas was significantly correlated with age.

Matched MeSH terms: Vena Cava, Inferior

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