52 - Implications of a Left-sided Inferior Vena Cava on Systemic Venous Compression

Poster Board Number: 52
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Odd poster #s – first hour
Even poster #s – second hour

Co-authors:

Ge Bai, MBS - Medical Student, Rutgers Robert Wood Johnson Medical School; Anna Da Silva - Graduate Student, Rutgers University School of Graduate Studies; Grace Enfield, PhD, ACUE - Assistant Professor, Director of Anatomical Association Whole Body Donor Program, Neuroscience and Cell Biology, Rutgers Robert Wood Johnson Medical School; Gail Elliott, PhD, AFHEA - Assistant Professor, Neuroscience and Cell Biology, Rutgers Robert Wood Johnson Medical School

Abstract Body : Introduction & Objective: Left-right (L-R) patterning plays a crucial role in the organization of the human body during fetal development. Deviations in the process of breaking L-R patterning symmetry in embryonic development contributes to anatomical anomalies that give rise to potential disorders and disease. In development of the mature IVC, deviations lead to atypical variations of the IVC, such as a left-sided IVC (LIVC). An LIVC develops due to a regression of the right supracardinal vein and persistence of the left supracardinal vein during the process of breaking symmetry in L-R patterning. The objective of this case study is to understand the clinical implications of atypical L-R patterning during development, as exemplified by the presence of a LIVC in a cadaver.



Materials and Methods: An 86-year-old female cadaver donor was examined through a dissection of the abdominal region. Liver measurements were also obtained to establish hepatomegaly. Ethical guidelines established by the Robert Wood Johnson Medical School Anatomical Association were adhered to throughout the study. Limitations of this study included inaccessibility to the medical records of the cadaver donor.



Results: The cadaver presented with an incomplete LIVC, where the left common iliac vein ascends as a tributary to a retained LIVC and crosses the abdominal aorta anteriorly before joining the proximal component of the IVC on the right side. When crossing the anterior face of the AA, the IVC is confined between the superior mesenteric artery and the AA, suggesting systemic venous compression. Liver measurements at the midclavicular and midsternal lines support a case of hepatomegaly, which can present secondarily to IVC constriction. The cadaver’s left kidney and left renal vein were significantly inferiorly displaced due to compression from the enlarged liver.



Conclusion: This study illustrates the role of embryonic development in establishing L-R patterning. The cadaver's case of an LIVC variation showcases the systemic complications that can arise when there are deviations in the process of the breaking of symmetry in L-R patterning.


Significance/Implication: Examination of the cadaver suggests an increased risk of venous blood coagulation and deep vein thrombosis (DVT), as well as a weakened myocardium in the right atrium. Thus, awareness of variations, such as LIVC, are crucial to clinical diagnosis and treatment planning. Knowledge of LIVC in young patients can reduce the risk for DVT through preventative anti-thrombotic treatment. LIVC also presents a unique challenge to surgical intervention, such as placing an IVC filter. The findings from this case study highlight the need for integrating knowledge of anatomical variations into clinical decision-making to improve patient outcomes.