PMC4857321_01
In the prone position, digital subtraction venography shows the patient's right external iliac vein and right caval system almost completely occluded with thrombus (white arrow). An IVC filter has been deployed in the duplicated left caval system (short black arrow).
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Next, via cannulation of the right lesser saphenous vein, venography was performed demonstrating near complete occlusion of the right leg venous system with extensive clot burden throughout (Figure 1).
Digital subtraction images depicting patient's true anatomy: venogram shows left-sided IVC with filter (black arrow), pre-aortic trunk (white arrow), and a wallstent (star) deployed in right infrarenal IVC.
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The diagnosis of a duplicated IVC was thus made (Figure 2).
Fluoroscopic image showing Bard Eclipse IVC filter placed in the infrarenal portion of left IVC (white arrow). Venogram of the right-sided duplicated IVC after angioplasty and stenting shows wide patency (star).
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Completion venography now showed wide patency of the right iliofemoral vessels with restoration of flow through the duplicated right IVC into the suprarenal IVC (Figures 3 and 4).
Cartoon depiction of anomalous anatomy shows pre-aortic trunk, stent placement in the infrarenal portion of the right IVC, and filter placed in the infrarenal portion of the left duplicated IVC.
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Completion venography now showed wide patency of the right iliofemoral vessels with restoration of flow through the duplicated right IVC into the suprarenal IVC (Figures 3 and 4).
A non-contrast enhanced CT scan done 3 years prior to the misidentification of the duplicated IVC as an enlarged left gonadal vein. Pre-aortic trunk (white arrow) and aorta (black arrow).
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Postoperative review of the patient's non-contrast computed tomography (CT) scan done 5 years prior had misidentified her left-sided IVC as an enlarged gonadal vein (Figure 5).