Absence of Middle Hepatic Vein Combined with Retro-Aortic Left Renal Vein: a Very Rare Case Report

Abstract

The hepatic and renal veins drain into the inferior vena cava. The upper group of hepatic veins consists of three veins which extend to the posterior face of the liver to join the inferior cava. The left renal vein passes anterior to the aorta just below the origin of the superior mesenteric artery. We detected a variation in the hepatic and renal veins in a multislice CT angiogram of a nine-year-old male patient in the Radiology Department of Afyon Kocatepe University Medical School. The upper group hepatic veins normally drains into the inferior vena cava as three separate trunks, namely the right, left and middle. In our case, we found that only the right and left hepatic veins existed and the middle hepatic vein was absent. Furthermore, the left renal vein, which normally passes anterior to the abdominal aorta, was retro-aortic. Left renal vein variations are of great importance in planning retroperitoneal surgery and vascular interventions. Knowledge of a patient's hepatic vein and renovascular anatomy and determining their variations and anomalies are of critical importance to abdominal operations, transplantations and preoperative evaluation of endovascular interventions. Turkish Başlık: Orta Hepatik Venin Olmaması İle Birlikte Retroaortik Renal Ven: Çok Nadir Bir Olgu Sunumu Anahtar Kelimeler: Varyasyon, orta hepatik ven, sol renal ven, BT Hepatik ve renal venler v. cava inferior'a açılırlar. Üst gruptaki hepatik venler üç venden meydana gelir ve bunlar karaciğerin arka yüzüne doğru uzanarak v. cava inferior'a açılırlar. V. renalis sinistra, a. mesenterica superior'un başlangıç kısmının hemen aşağısında aorta'nın ön tarafından geçer. Biz Afyon Kocatepe Üniversitesi Tıp Fakültesi Radyoloji Anabilim Dalı'nda 9 yaşında erkek hastanın multislice BT anjiografisinde hepatik ve renal venlerinde varyasyon saptadık. Normalde üst grup hepatik venler sağ, sol ve orta olarak adlandırılan üç ayrı gövde şeklinde v. cava inferior'a açılırlar. Olgumuzda sadece sağ ve sol hepatik venlerin var olduğunu, orta hepatik venin olmadığını bulduk. Ayrıca, normalde aorta abdominalis'in ön tarafından geçmesi gereken v. renalis sinistra, retroaortik idi. V. renalis sinistra varyasyonları retroperitoneal cerrahi ve vasküler girişimlerin planlanmasında büyük öneme sahiptir. Hepatik ven ve böbrek damar anatomisinin bilinmesi ve bu damarların varyasyonlarının ve anomalilerinin tespit edilmesi, abdominal operasyonlar, organ nakilleri ve endovasküler girişimlerin preoperatif değerlendirmelerinde kritik öneme sahiptir.

Keywords

• Variation, middle hepatic vein, left renal vein, CT

Absence of Middle Hepatic Vein Combined with Retro-Aortic Left Renal Vein: a Very Rare Case Report

Öz

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