Duplicated inferior vena cava with complex vascular malformation

Case contributed by Lemuel Marquez Narcise
Diagnosis certain


Enlarging pulsatile mass in the left inguinal region. History of a gunshot wound to the left thigh since childhood.

Patient Data

Age: 55 years
Gender: Male

Prominent left pelvic, inguinal, and proximal lower extremity vascular malformation. The left common femoral artery and left common femoral vein are markedly dilated with an apparent fistulous connection. The veins draining into the left femoral vein in the adductor and vastus lateralis regions are prominent. The left common iliac and left external iliac arteries are prominent and tortuous. The left external iliac and left common iliac veins are markedly dilated; the left common iliac vein appears to communicate with the distal abdominal aorta at the region of the aortic bifurcation. The left common iliac vein appears to drain into a duplicated inferior vena cava at the left side of the abdominal aorta, which further drains into the left renal vein. The hepatic segment of the normal right-sided inferior vena cava and the hepatic veins are prominent. The rest of the normal right-sided inferior vena cava is intact in caliber. The internal pudendal veins and prostatic venous plexus are prominent. The abdominal aorta is intact in caliber. 

3D volume rendering image shows the duplicated inferior vena cava and complex pelvic-inguinal vascular malformation.

Case Discussion

This is an unusual case of a complex vascular malformation in the pelvic-inguinal region with an incidental finding of left-sided or duplicated inferior vena cava. It is possible that the pelvic-inguinal vascular malformation is post-traumatic in etiology with a history of a gunshot wound to the left thigh, as arteriovenous fistulae may develop and can remain asymptomatic for years. The duplicated inferior vena cava is a congenital variant that is an incidental finding on the only CT imaging study, and this unusual caval abnormality can present an interesting challenge in the surgical or endovascular treatment of the aforementioned complex vascular malformation.

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