Year : 2002 | Volume
: 18 | Issue : 2 | Page : 163--164
Case report : Duplication of the IVC with ectopic kidney and PUJ obstruction
Viswaroop S Bobby, L Raghuram, K Ninan Chacko
Department of Urology and Radiodiagnosis, Christian Medical College and Hospital, Vellore, India
K Ninan Chacko
Department of Urology, Christian Medical College and Hospital, Vellore (T.N.) - 632 004
|How to cite this article:|
Bobby VS, Raghuram L, Chacko K N. Case report : Duplication of the IVC with ectopic kidney and PUJ obstruction.Indian J Urol 2002;18:163-164
|How to cite this URL:|
Bobby VS, Raghuram L, Chacko K N. Case report : Duplication of the IVC with ectopic kidney and PUJ obstruction. Indian J Urol [serial online] 2002 [cited 2019 Oct 23 ];18:163-164
Available from: http://www.indianjurol.com/text.asp?2002/18/2/163/37627
Anomalies of the IVC are not uncommon and are relevant to urologists, radiologists and vascular surgeons. With modern imaging techniques it is possible to accurately visualize the retroperitoneum. This has led to a renewed appreciation of the incidence of these venous anomalies. Duplication of the IVC is associated with various genitourinary and vascular malformations. To the best of our knowledge this is the first case report of duplication of the IVC with an ectopic kidney having PUJ obstruction.
A 31-year-old male presented with recurrent left iliac fossa pain of 9 months duration. An ultrasound showed an ectopic left kidney with dilated extrarenal pelvis. The IVU showed the ectopic kidney overlying the lumbosacral region with pelvicalyciectasia. The ureter was not visualized in any of the films. A CT scan showed left hydronephrotic (pelvic) ectopic kidney with double IVC [Figure 1],[Figure 2]. He underwent left-dismembered pyeloplasty with an uneventful post-op recovery.
The embryogenesis of IVC is complex involving development, regression, anastomosis and replacement of three pairs of venous channels; posterior cardinal, subcardinal and supracardinal veins.  Dysplasia of the IVC in 78th weeks of embryogenesis gives rise to various IVC anomalies  (circum aortic venous ring, retrocaval ureter, duplication of IVC, left-sided IVC, azygous venous continuation), which were classified by Huntington and McClure.' The incidence of IVC duplication is 0.2 to 3%.  It results froth the persistence of the left supracardinal vein. It is classified based on size of each segment and the level it crosses the midline. Most of these anomalies are incidentally detected or during evaluation of an unexplained hematuria. 
Various genitourinary anomalies are reported along with the vascular anomalies (viz. - cloacal extrophy, PUJ obstruction, horseshoe kidney, polycystic kidney,  KlippelTrenaunay syndrome,  renal tumour  ) but, the association with ectopic kidney has not been reported. A thorough search of the literature using Medline did not reveal any such report. Although the exact cause and effect of such an association is not known, abnormal venous development can be the cause for impaired renal ascent. Contrastenhanced CT scan can clearly differentiate vascular and non-vascular structures and has remained the diagnostic method of choice. Knowledge of the vascular tree is important when operating on anomalously placed kidneys.
|1||Chaung VP, Mena E, Hoskins PA. Congenital anomalies of the inferior venacava: Review of embryogenesis and presentation of a simplified classification. Br J Radiol 1974: 47: 206.|
|2||Hayashi M, Kume T, Nihira H. Abnormalities of renal venous system and unexplained renal hematuria. J Urol 1980; 124: 12-16.|
|3||Mayo J, Gray R, St. Louis E et al. Anomalies of the inferior vena cava. AJR 1983; 140: 339-344.|
|4||Mani NBS, Venkataramu NK, Paramjeet Singh, Sudha Suri. Case report. Duplication of IVC and associated renal anomalies. IJRI 2000; 10: 2-3.|
|5||Schofield D, Zaatari GS, Gay BB. Klippel-Trenaunay and SturgeWeber syndromes with renal hemangioma and double inferior vena cava. J Urol 1986; 136: 442-445.|
|6||Habuchi T, Okagaki T, Arai K, Miyakawa M. Renal cell carcinoma extending into left side of double inferior vena cava. Urology 1993; 41: 181-184.|