DOCSLIB.ORG

Rare Case of a Kidney and Inferior Vena Cava Abnormalities With

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Rare Case of a Kidney and Inferior Vena Cava Abnormalities With Clinics and Practice 2018; volume 8:1079 Rare case of a kidney and inferior vena cava Case Report Correspondence: Timir K. Paul, Division of Cardiology, Department of Medicine, East abnormalities with extensive A 27-year-old male with no significant Tennessee State University, 329 N State of lower extremity deep vein past medical history was admitted with Franklin Rd, Johnson City, TN 37604, USA. right lower extremity pain and swelling that Tel.: 423.979.4100 - Fax: 423.979.4134. thrombosis in a young started a week ago. Patient first noted E-mail: [email protected] healthy male swelling in the right ankle that was associ- ated with pain in the calf and thigh. Pain Key words: Deep vein thrombosis; Inferior vena cava hypoplasia; Renal hypoplasia. was described as progressively worsening Muhammad Khalid,1 1 1 with tightness and heaviness in the affected Contributions: MK wrote the initial manu- Manisha Nukavarapu, Rupal Shah, leg that was exacerbated with ambulation. 2 script draft and literature review; MN and RS Timir K. Paul Patient endorsed recent short duration of reviewed the initial draft with editions and TK 1Department of Medicine; 2Division of immobility involving a 4 hour road trip but did final revision and any edition as needed. Cardiology, Department of Medicine, denied any recent surgery, prior history of thrombosis, weight changes, new bone pain, Conflict of interest: the authors declare no East Tennessee State University, potential conflict of interest. Johnson City, TN, USA or history of easy bruising or bleeding. No known history of any congenital abnormal- Funding: none. ities, intra uterine growth restriction, oligo- hydramnios and no pregnancy related com- Received for publication: 6 May 2018. plications was reported. Revision received: 24 September 2018. Abstract Vitals on admission included blood Accepted for publication: 25 September 2018. pressure B.P 133/98 mm Hg, pulse rate of Kidney and inferior vena cava (IVC) This work is licensed under a Creative abnormalities with extensive deep vein 100 beats per minutes, respiratory rate 18 Commons Attribution NonCommercial 4.0 thrombosis (DVT) is a very rare cause of per minute, temperature of 97.8 F, and nor- Licenseonly (CC BY-NC 4.0). DVT and has a diverse clinical presentation. mal oxygen saturation on room air. Physical Computed tomography (CT) angiography is examination was significant for right lower ©Copyright M. Khalid et al., 2018 extremity swelling most prominent at the Licensee PAGEPress, Italy the gold standard for diagnosis and treat- thigh with mild erythema and calf tender- Clinics and Practice 2018; 8:1079 ment including thrombectomy, thromboly- ness. Laboratory showed normal bloodusedoi:10.4081/cp.2018.1079 sis and systemic anticoagulation. We pres- counts, liver and kidney functions. ent a rare case of active young healthy male Patient initially received full dose of admitted with acute onset of right lower Lovenox that was switched to low molecu- extremity pain and swelling who was found lar weight heparin infusion. CT scan of anticoagulation. Patient was found to have to have extensive DVT on doppler ultra- chest, abdomen and pelvis was obtained to extensive thrombosis of the pelvic veins on sound. CT abdomen showed extensive clot evaluate potential etiology of thrombosis angiogram. Based on CT scan and burden involving right common femoral and extent of DVT. CT scan ruled out pul- angiogram findings, our patients has con- vein extending into internal and external monary embolus and revealed an extensive genital anomaly of inferior vena cava with iliac veins associated with IVC hypoplasia DVT of the right common femoral vein, left no intrahepatic portion of the IVC, and and hypoplastic left kidney. Patient under- common iliac vein, left internal and external hepatic veins drain into the azygous venous went urgent thrombectomy, catheter direct- iliac veins. There was an incidental finding system which continues into the superior ed thrombolysis and was discharged home of congenital inferior vena cava (IVC) vena cava which can sometimes mimic with in stable condition on oral anticoagulation. anomaly, with no intrahepatic portion of chronic inferior vena cava occlusion with inferior vena cava, and a hypoplastic left venous thrombosis usually associated with kidney (Figure 1A-C). Further evaluation of significant venous collaterals. The patient Non-commercialthe right lower extremity with doppler ultra- was subsequently treated with direct throm- Introduction sound revealed acute thrombus occluding bolysis, mechanical thrombectomy and bal- the common femoral, profunda femoral and loon angioplasty (Figure 3A-C). Post Kidney and inferior vena cava abnor- popliteal veins (Figure 1D). Left lower thrombolysis catheter showed contrast flow malities with leg thrombosis (KILT) syn- extremity doppler study was negative for from left iliac vein to right iliac vein and drome is most commonly seen as an inci- DVT. CT scan showed continuation of azy- lumbar vein with no inferior vena cava seen dentally finding on imaging studies espe- gous vein into the superior vena cava via (Figure 3D). Oncology recommended life- cially in a young population. It is a rare azygous arch which has been highlighted in long anticoagulation because of unpro- cause of deep vein thrombosis with very detail in (Figure 2A-E). There was no sig- voked DVT, extent of thrombosis with mul- few case reports in literature so far. We nificant venous collaterals found on CT tiple risk factors including IVC abnormali- present a case of 27-year-old young healthy scan after discussion with the radiologist. ties. Patient was started on rivaroxaban on discharge and instructed to use elastic male admitted with right leg pain who was Hypercoagulable work up was ordered. stockings, and to avoid excessive exercise, found to have extensive deep vein thrombo- Factor V Leiden, prothrombin mutation and immobilization and smoking. sis (DVT) of right lower extremity extend- anticardiolpin antibody were negative. ing into the common femoral vein, pelvic Testing for protein C, protein S, antithrom- and abdominal veins with kidney and infe- bin III, lupus anticoagulant was deferred rior vena cava abnormalities. because of difficulty of interpretation of Discussion these results in the setting of an acute venous thromboembolism and systemic KILT syndrome was first reported by [page 95] [Clinics and Practice 2018; 8:1079] Case Report Van Veen et al.1 It is a triad of kidney and IVC abnormalities and leg thrombosis. Only few case report studies have been reported in the literature. Inferior vena cava hypoplasia is an uncommon congenital cause of ilio-femoral DVT especially in young patients, accounting for 5% cases of DVT under 30 years old2 and having a prevalence rate of % in the general popula- tion.3 IVC embryogenesis is very complex and involves confluence of three sets of the fetal veins, the posterior cardinal, sub cardi- nal, and supracardinal veins. There are four different parts to the IVC, which are hepat- ic, supra renal, renal and infra renal. The possible etiology of IVC atresia/hypoplasia is felt to be due to intrauterine or perinatal thrombosis of IVC, resulting in occlusion and disappearance or hypoplasia of IVC.4 The most common congenital anomalies are duplication of IVC, IVC continued with intra thoracic azygous vein, left sided IVC, IVC agenesis and retro aortic left renal vein. IVC abnormalities have a reported preva- lence of 0.07-8.5% in the general popula- only tion. IVC hypoplasia/agenesis usually Figure 1. (A-C) Computed tomography scan of the abdomen showed absent intra-hepat- results in the extensive collateral formation ic portion of IVC and confluence of hepatic veins, hypoplastic left kidney and absent both hepatic and renal portions of the inferior vena cava (arrows). (D) Doppler ultra- which results in the slow venous flow from sound clot in the deep veins of right leg (arrow). the lower extremity ended up with the increased venous pressure, venous stasis use and recurrent DVT.4 Agenesia of IVC has already been reported in the literature to be associated with extensive DVT.5 Duciu et al.6 first reported a case of KILT syndrome in sib- lings. DVT can be either provoked or unprovoked. Factors that are involved in provoked DVT include recent surgery, pro- long immobilization, trauma, pregnancy, obesity, smoking, recent travel, lupus anti- coagulant, use of oral contraceptive pills and malignancy. If there are no obvious pre- disposing factors present, then DVT is most likely unprovoked which can be due to the absence of protein C, Protein S, antithrom- bin III, factor V/prothrombin geneNon-commercial mutation or congenital IVC anomalies. Most of the patients are asymptomatic prior to diagnosis and, if symptomatic, clinical presentation can be diverse including lower limb pain and swelling, loin pain, hematuria, back pain, and lower extremity ulcers.7 Pulmonary embolus is rarely seen with KILT syndrome, because the embolus is usually trapped in the azygous vein, which prevents propagation to the pulmonary cir- culation. The typical presentation of KILT syn- drome are in male patients presenting with extensive or bilateral DVT in the setting of physical exertion and associated with phys- ical exertion. Shaline et al. reported a case Figure 2. Computed tomography scan demonstrates azygous continuation from the of IVC atresia presenting with DVT associ- hepatic veins into the superior vena cava as continuation of the hepatic veins (arrows). ated in the setting of physical exertion.8 The [Clinics and Practice 2018; 8:1079] [page 96] Case Report DVT commonly involves distal IVC, com- have also been reported as seen in our different diagnostic modalities that may be mon, internal and external iliac and femoral patient.10 used to diagnose DVT. CT venography is veins. Our patient was physically very Usually, patients with unexplained or the gold standard to diagnose DVT but it active and CT scan showed DVT of the unproved DVT required hypercoaguable has been replaced by regular ultrasound due right common femoral vein through com- work up which could be the possible expla- to invasive in nature.
Load more

Recommended publications
  • Anatomy of the Large Blood Vessels-Veins
    Anatomy of the large blood vessels-Veins Cardiovascular Block - Lecture 4 Color index: !"#$%&'(& !( "')*+, ,)-.*, $()/ Don’t forget to check the Editing File !( 0*"')*+, ,)-.*, $()/ 1$ ($&*, 23&%' -(0$%"'&-$(4 *3#)'('&-$( Objectives: ● Define veins, and understand the general principles of venous system. ● Describe the superior & inferior Vena Cava and their tributaries. ● List major veins and their tributaries in the body. ● Describe the Portal Vein. ● Describe the Portocaval Anastomosis Veins ◇ Veins are blood vessels that bring blood back to the heart. ◇ All veins carry deoxygenated blood. with the exception of the pulmonary veins(to the left atrium) and umbilical vein(umbilical vein during fetal development). Vein can be classified in two ways based on Location Circulation ◇ Superficial veins: close to the surface of the body ◇ Veins of the systemic circulation: NO corresponding arteries Superior and Inferior vena cava with their tributaries ◇ Deep veins: found deeper in the body ◇ Veins of the portal circulation: With corresponding arteries Portal vein Superior Vena Cava ◇Formed by the union of the right and left Brachiocephalic veins. ◇Brachiocephalic veins are formed by the union of internal jugular and subclavian veins. Drains venous blood from : ◇ Head & neck ◇ Thoracic wall ◇ Upper limbs It Passes downward and enter the right atrium. Receives azygos vein on its posterior aspect just before it enters the heart. Veins of Head & Neck Superficial veins Deep vein External jugular vein Anterior Jugular Vein Internal Jugular Vein Begins just behind the angle of mandible It begins in the upper part of the neck by - It descends in the neck along with the by union of posterior auricular vein the union of the submental veins.
    [Show full text]
  • Vessels and Circulation
    CARDIOVASCULAR SYSTEM OUTLINE 23.1 Anatomy of Blood Vessels 684 23.1a Blood Vessel Tunics 684 23.1b Arteries 685 23.1c Capillaries 688 23 23.1d Veins 689 23.2 Blood Pressure 691 23.3 Systemic Circulation 692 Vessels and 23.3a General Arterial Flow Out of the Heart 693 23.3b General Venous Return to the Heart 693 23.3c Blood Flow Through the Head and Neck 693 23.3d Blood Flow Through the Thoracic and Abdominal Walls 697 23.3e Blood Flow Through the Thoracic Organs 700 Circulation 23.3f Blood Flow Through the Gastrointestinal Tract 701 23.3g Blood Flow Through the Posterior Abdominal Organs, Pelvis, and Perineum 705 23.3h Blood Flow Through the Upper Limb 705 23.3i Blood Flow Through the Lower Limb 709 23.4 Pulmonary Circulation 712 23.5 Review of Heart, Systemic, and Pulmonary Circulation 714 23.6 Aging and the Cardiovascular System 715 23.7 Blood Vessel Development 716 23.7a Artery Development 716 23.7b Vein Development 717 23.7c Comparison of Fetal and Postnatal Circulation 718 MODULE 9: CARDIOVASCULAR SYSTEM mck78097_ch23_683-723.indd 683 2/14/11 4:31 PM 684 Chapter Twenty-Three Vessels and Circulation lood vessels are analogous to highways—they are an efficient larger as they merge and come closer to the heart. The site where B mode of transport for oxygen, carbon dioxide, nutrients, hor- two or more arteries (or two or more veins) converge to supply the mones, and waste products to and from body tissues. The heart is same body region is called an anastomosis (ă-nas ′tō -mō′ sis; pl., the mechanical pump that propels the blood through the vessels.
    [Show full text]
  • Cat Dissection
    Cat Dissection Muscular Labs Tibialis anterior External oblique Pectroalis minor Sartorius Gastrocnemius Pectoralis major Levator scapula External oblique Trapezius Gastrocnemius Semitendinosis Trapezius Latissimus dorsi Sartorius Gluteal muscles Biceps femoris Deltoid Trapezius Deltoid Lumbodorsal fascia Sternohyoid Sternomastoid Pectoralis minor Pectoralis major Rectus abdominis Transverse abdominis External oblique External oblique (reflected) Internal oblique Lumbodorsal Deltoid fascia Latissimus dorsi Trapezius Trapezius Trapezius Deltoid Levator scapula Deltoid Trapezius Trapezius Trapezius Latissimus dorsi Flexor carpi radialis Brachioradialis Extensor carpi radialis Flexor carpi ulnaris Biceps brachii Triceps brachii Biceps brachii Flexor carpi radialis Flexor carpi ulnaris Extensor carpi ulnaris Triceps brachii Extensor carpi radialis longus Triceps brachii Deltoid Deltoid Deltoid Trapezius Sartorius Adductor longus Adductor femoris Semimembranosus Vastus Tensor fasciae latae medialis Rectus femoris Vastus lateralis Tibialis anterior Gastrocnemius Flexor digitorum longus Biceps femoris Tensor fasciae latae Semimembranosus Semitendinosus Gluteus medius Gluteus maximus Extensor digitorum longus Gastrocnemius Soleus Fibularis muscles Brachioradiallis Triceps (lateral and long heads) Brachioradialis Biceps brachii Triceps (medial head) Trapezius Deltoid Deltoid Levator scapula Trapezius Deltoid Trapezius Latissimus dorsi External oblique (right side cut and reflected) Rectus abdominis Transversus abdominis Internal oblique Pectoralis
    [Show full text]
  • Surgical Anatomy of the Common Iliac Veins During Para-Aortic and Pelvic Lymphadenectomy for Gynecologic Cancer
    Original Article J Gynecol Oncol Vol. 25, No. 1:64-69 http://dx.doi.org/10.3802/jgo.2014.25.1.64 pISSN 2005-0380·eISSN 2005-0399 Surgical anatomy of the common iliac veins during para-aortic and pelvic lymphadenectomy for gynecologic cancer Kazuyoshi Kato, Shinichi Tate, Kyoko Nishikimi, Makio Shozu Department of Gynecology, Chiba University School of Medicine, Chiba, Japan See accompanying editorial by Lee on page 1. Objective: Compression of the left common iliac vein between the right common iliac artery and the vertebrae is known to be associated with the occurrence of left iliofemoral deep vein thrombosis (DVT). In this study, we described the variability in vascular anatomy of the common iliac veins and evaluated the relationship between the degree of iliac vein compression and the presence of DVT using the data from surgeries for gynecologic cancer. Methods: The anatomical variations and the degrees of iliac vein compression were determined in 119 patients who underwent systematic para-aortic and pelvic lymphadenectomy during surgery for primary gynecologic cancer. Their medical records were reviewed with respect to patient-, disease-, and surgery-related data. Results: The degrees of common iliac vein compression were classified into three grades: grade A (n=28, 23.5%), with a calculated percentage of 0%-25% compression; grade B (n=47, 39.5%), with a calculated percentage of 26%-50% compression; and grade C (n=44, 37%), with a calculated percentage of more than 50% compression. Seven patients (5.9%) had common iliac veins with anomalous anatomies; three were divided into small caliber vessels, two with a flattened structure, and two had double inferior vena cavae.
    [Show full text]
  • Pelvic Venous Reflux Diseases
    Open Access Journal of Family Medicine Review Article Pelvic Venous Reflux Diseases Arbid EJ* and Antezana JN Anatomic Considerations South Charlotte General and Vascular Surgery, 10512 Park Road Suite111, Charlotte, USA Each ovary is drained by a plexus forming one major vein *Corresponding author: Elias J. Arbid, South measuring normally 5mm in size. The left ovarian plexus drains into Charlotte General and Vascular Surgery, 10512 Park Road left ovarian vein, which empties into left renal vein; the right ovarian Suite111, Charlotte, NC 28120, USA plexus drains into the right ovarian vein, which drains into the Received: November 19, 2019; Accepted: January 07, anterolateral wall of the inferior vena cava (IVC) just below the right 2020; Published: January 14, 2020 renal vein. An interconnecting plexus of veins drains the ovaries, uterus, vagina, bladder, and rectum (Figure 1). Introduction The lower uterus and vagina drain into the uterine veins and Varicose veins and chronic venous insufficiency are common then into branches of the internal iliac veins; the fundus of the uterus disorders of the venous system in the lower extremities that have drains to either the uterine or the ovarian plexus (utero-ovarian and long been regarded as not worthy of treatment, because procedures salpingo ovarian veins) within the broad ligament. Vulvoperineal to remove them were once perceived as worse than the condition veins drain into the internal pudendal vein, then into the inferior itself. All too frequently, patients are forced to learn to live with them, gluteal vein, then the external pudendal vein, then into the saphenous or find "creative" ways to hide their legs.
    [Show full text]
  • Sources of Venous Blood Supply of Kidneys in Chicken of Haysex White Breed
    M. V. Pervenetskaya et al /J. Pharm. Sci. & Res. Vol. 10(10), 2018, 2639-2641 Sources of Venous Blood Supply of Kidneys in Chicken of Haysex White Breed M. V. Pervenetskaya, L. V. Fomenko, G. A. Honin Omsk State Agrarian University named after P.A. Stolypin, 644008, Omsk, Russian Federation, Institutskaya Square, 1 Abstract: As a result of our studies, it has been found that blood from pelvic extremities in chicken flows along the right and left external iliac veins into the pelvic cavity. The caudal portal vein of the kidney branches from it in the caudal direction - from cranial part of kidneys. The caudal portal vein collects blood from middle and caudal parts of the kidney. The caudal portal vein, slightly bending in the caudomedial direction, joins the caudal portal vein from the opposite side. Coccygeal mesenteric vein branches from junctions of these veins. The right and left renal veins when joining together with an acute angle flow into the common iliac vein, which in turn enters caudal vena cava. Intraorgan veins of the kidney are divided into interlobular, perilobular, intralobular veins and capillaries. Venous blood from kidneys flows by three different ways. The first way is carried out by the hepatic veins from the midst and caudal parts of kidney. Firstly, these veins flow into the common iliac vein, and then into the caudal part of vena cava. The second way of outflow is carried out through the coccygeal mesenteric vein in the liver. The third way is carried out along the right and left cranial anterior portal veins from the anterior part of the kidney into the vertebral venous canal.
    [Show full text]
  • Anatomy of Pelvic Leak Points in the Context of Varicose Veins Anatomie Von Becken-Leckage-Punkten Im Zusammenhang Mit Varizen
    Published online: 2021-01-18 Schwerpunktthema Anatomy of Pelvic leak points in the context of varicose veins Anatomie von Becken-Leckage-Punkten im Zusammenhang mit Varizen Author Roberto Delfrate Affiliation have their origin in pelvic leaks points, this incidence is 4 times Figlie San Camillo Hospital, Cremona, Italy higher in multiparous than in nulliparous. Claude Franceschi first analyzed and described the reflux pathways for this pelvic Key words leak points. The most frequently involved escape points or parietal pelvic leak points PLPs, varicose veins of pelvic origin “Pelvic Leak Points” are the perineal points (PP), draining Schlüsselwörter through the labial region to the leg and the inguinal points parietale Becken-Leckage-Punkte, PLPs, Varizen mit pelvinem through the inguinal ring (IP). Others are the Clitoridian point Ursprung (CP), gluteal points (GP) and obturatorian point (OP). Their in- vestigation has to be performed in standing position and published online 18.01.2021 using Valsalva – but the most important part of the investiga- tion is the anatomic knowledge about the different pathways. Bibliography Phlebologie 2021; 50: 42–50 ZUSAMMENFASSUNG DOI 10.1055/a-1309-0968 Venennetze des Beckens (eigenständig oder nicht) können ISSN 0939-978X Ausgangspunkt für einen Reflux in die oberflächlichen Beinve- © 2021. Thieme. All rights reserved. nen sein. Sie sind häufig an Rezidiven nach klassischen Venen- Georg Thieme Verlag KG, Rüdigerstraße 14, behandlungen beteiligt, da sie in diesem Zusammenhang 70469 Stuttgart, Germany nicht mitbehandelt werden. Studien auf der Grundlage ver- Correspondence schiedener Untersuchungen (Klinik, Ultraschall, Phlebografie) Dr. Roberto Delfrate kommen zu dem Ergebnis, dass bei etwa 10 % der Frauen mit Figlie San Camillo Hospital, Cremona, 56 Fabio Filzi st, Varizen die Ursache in den pelvinen Leckagen liegt.
    [Show full text]
  • A Modified Incision for Upper Abdominal Surgery in Portal Hypertension Patients: Could It Avoid Portal Vein Thrombosis? JSM Gastroenterol Hepatol 2(3): 1022
    Central JSM Gastroenterology and Hepatology Mini Review *Corresponding author Rafael S. Pinheiro, Department of Gastroenterology, University of São Paulo, Hospital das Clínicas, Rua A modified incision for upper Dr. Enéas de Carvalho Aguiar, 255, 9º andar - sala 9113/9114, CEP 05403-900 - São Paulo – SP – Brazil, Tel : 55 11 26613323, Fax: 55 11 2661-6250, E-mail: abdominal surgery in portal Submitted: 16 February 2014 hypertension patients: could it Accepted: 28 February 2014 Published: 05 March 2014 Copyright avoid portal vein thrombosis? © 2014 Pinheiro et al. Wellington Andraus1, Jan Lerut2, Rafael S. Pinheiro1,2 *, Lucas C. OPEN ACCESS Nacif1, Luciana B. Haddad1, Paulo Herman1 and Luiz Carneiro D’Albuquerque1 1Department of Gastroenterology, University of São Paulo Medical School, Brazil 2Starzl Unit of Abdominal Transplantation, University Hospitals Saint Luc, Université catholique Louvain, Belgium Abstract Background: Portal hypertension is caused by high resistance in portal system due to hepatic fibrosis or pre-sinusoidal obstruction, such as seen in schistosomiasis. The paraumbilical vein recanalization a frequent event in these patients seems to be an efficient portal decompression pathway. A new incision avoiding ligation of the round ligament for major surgeries at the upper abdominal quadrants in portal hypertension patients is proposed: a left subcostal with a small median extension. This incision offers excellent exposure of spleen, stomach, and esophagus whilst keeping the paraumbilical vein intact. This allows to left an adequate flow in portal trunk. Conclusion: The proposed technical modification proposed is an attractive option because it can reduce the incidence of portal vein thrombosis and postoperative bleeding from esophageal varices. INTRODUCTION the procedure of choice for portal hypertension in patients with Portal hypertension is caused by high resistance in the portal schistosomiasisthe azygo-portal in disconnection the majority andof specialized splenectomy centers.
    [Show full text]
  • Embolization of the Ovarian and Iliac Veins for Pelvic Congestion Syndrome
    UnitedHealthcare® Commercial Medical Policy Embolization of the Ovarian and Iliac Veins for Pelvic Congestion Syndrome Policy Number: 2021T0574K Effective Date: May 1, 2021 Instructions for Use Table of Contents Page Related Commercial Policy Coverage Rationale ........................................................................... 1 • Surgical and Ablative Procedures for Venous Definitions ........................................................................................... 1 Insufficiency and Varicose Veins Applicable Codes .............................................................................. 2 Description of Services ..................................................................... 2 Community Plan Policy Clinical Evidence ............................................................................... 2 • Embolization of the Ovarian and Iliac Veins for Pelvic U.S. Food and Drug Administration ................................................ 4 Congestion Syndrome References ......................................................................................... 5 Policy History/Revision Information................................................ 6 Instructions for Use ........................................................................... 6 Coverage Rationale Embolization of the Ovarian Vein or Internal Iliac Vein is unproven and not medically necessary for treating Pelvic Congestion Syndrome due to insufficient evidence of efficacy. Definitions Embolization: A procedure that uses particles, such as tiny
    [Show full text]
  • Blood Cell Models
    BLOOD CELL MODELS Erythrocyte Platelet BLOOD CELL MODELS Neutrophil Eosinophil BLOOD CELL MODELS Basophil Monocyte BLOOD CELL MODELS Lymphocyte BLOOD CELL MODELS BLOOD CELL MODELS BLOOD CELL MODELS BLOOD CELL MODELS BLOOD SMEAR SLIDES Erythrocyt es Platelets Neutrophi l Eosinophil Lymphocyt e Monocyt e Basophil BLOOD SMEAR SLIDES HEART MODEL Brachiocephalic Artery Left Common Carotid Artery ANTERIOR VIEW LEFT VIEW Left Subclavian Superior Artery Vena Aortic Arch Cava Pulmonary Ligamentum Arteriosus Right Trunk Aortic Aorta Atrium Arch Pulmonary Arteries Pulmonary Coronary Veins Arteries Left Atrium Left Ventricle Right Ventricle Interventricular Sulcus (groove between ventricles) ANTERIOR VIEW Brachiocephalic Artery HEART MODEL ANTERIOR VIEW Left Common Carotid Artery Aortic Pulmonary Superior Left Subclavian Artery Arch Arteries Vena Cava Pulmonary Aortic Trunk Arch Right Pulmonary Semilunar Atrium Bicuspid Valve Aorta Valve Aortic Semilunar Valve Interventricular Septum (Separates ventricles) Tricuspid Valve Left Ventricle Chordae Pulmonary Tendineae Veins Right Left Ventricle Atrium Endocardium (inner layer) Left Myocardium (muscle layer) Papillary Muscles Ventricle Epicardium (outer layer) HEART MODEL Superior Superior Vena Vena Cava Cava RIGHT VIEW Pulmonary Trunk Aorta Right Aorta Atrium Right Right Ventricle Ventricle Fossa Ovalis Tricuspid Valve Right Inferior Atrium Vena Cava HEART MODEL Brachiocephalic Artery Brachiocephalic Left POSTERIOR VIEW Artery Subclavian Left Artery Common Left Carotid Common Artery Carotid Left Artery
    [Show full text]
  • Cavoportal Hemitransposition for the Simultaneous Thrombosis of the Caval and Portal Systems - a Review of the Literature
    medigraphic Artemisaen línea 200 Annals ofAnnals Hepatology of Hepatology 2008; 7(3): 7(3) July-September: 2008: 200-211 200-211 Concise Review Annals of Hepatology Cavoportal hemitransposition for the simultaneous thrombosis of the caval and portal systems - A review of the literature Dietmar H. Borchert1 Abstract viewed together with the possible medical, radiological and non-transplant treatment options. This article eval- Portal venous thrombosis was originally considered to uates the available literature and reviews the evolution be a contraindication for liver transplantation. Cur- of the surgical procedure of cavoportal hemitransposi- rently, several methods exist to re-establish blood flow tion emphasising its role in combined thrombosis of the to the hepatic portal system. Cavoportal hemitranspo- hepatic veins and portal venous systems. sition is a surgical procedure that can be used in liver transplantation when the portal venous system is Key words: CPHT cavoportal hemitransposition, thrombosed and portal flow cannot be re-established PCHT portocaval hemitransposition, CPT cavoportal from the mesenteric venous system. In cavoportal transposition, BCS Budd-Chiari Syndrome, PVT portal hemitransposition the blood flow from the inferior vena vein thrombosis, liver disease, liver failure; transplan- cava of the recipient is directed to the portal vein of the tation. donor liver to compensate for the lost portal venous supply. This can either be done by end-to-end or end- Introduction to-side anastomosis. Seventy-one cases of cavoportal hemitransposition have been reported worldwide. All The Budd-Chiari Syndrome (BCS) is caused by hepat- patients reported had been in a critical and life-threat- ic venous outflow obstruction. This obstruction can be at ening condition, presenting with either end–stage–liver different levels and present as a complete or incomplete disease or acute hepatic failure combined with severe obstruction.
    [Show full text]
  • Segmental Vessels, Joining the Lumbar Veins at a Period Considerably Later Than That at Which the Two Posterior Cardinal Veins Are First Developed
    A CASE OF LEFT INFERIOR VENA CAVA OCCURRING IN A FEMALE SUBJECT IN WHOM THE LEFT SUPERIOR INTER- COSTAL VEIN JOINED THE VENA AZYGOS MAJOR, AND THE TWELFTH RIBS WERE ABSENT. By REGINALD J. GLADSTONE, M.D., F.R.C.S., F.R.S.E., Lecturer on Embryology, and Senior Demonstrator of Anatomy, Middlesex Hospital Medical School, London. THE specimen of left inferior vena cava which forms the subject of this paper (see figs. 1 and 2) illustrates not only the persistence of the left posterior cardinal vein in place of the right, but also what I find to be a frequent mode of origin of the vena azygos major, namely, by the union of three tributaries: (1) a large right subcostal vein, which is joined by (2) the right ascending lumbar vein, and (3) a communicating branch from the back of the inferior vena cava or one of its tributaries, most commonly the right renal, or one of the lumbar veins. The communicating vein usually ascends under cover of the right crus of the diaphragm, after having either pierced the crus or passed through the aortic opening along with the commencement of the thoracic duct. The communicating vein is often absent, and when present is usually small; in the former cases the vena azygos major arises by the junction of the right ascending lumbar vein, with the right subcostal vein, and does not pass through the aortic opening of the diaphragm. In the specimen under consideration the com- municating branch (fig. 2) was connected below with the termination of a left lumbar trunk, which joined the inferior vena cava at the level of the 4th lumbar vertebra (22nd V.); it ran upward on the vertebral column, behind the left renal vein and inferior vena cava, and then crossed obliquely behind the aorta to the interval between this vessel and the right crus of the diaphragm.
    [Show full text]