Presentation
Dyspnea and cough.
Patient Data
Marked dilatation of the pulmonary trunk (6.7 cm) with the right (5.4 cm) and left (4 cm) main branches. Lung window shows mild bilateral diffuse faint groundglass centrilobular lung nodules that may reflect an underlying infection.
Scans through the upper abdomen revealed average size cirrhotic liver and reflux of contrast into the IVC and hepatic veins with Incidental opacification of accessory right inferior hepatic vein.
Also noted, infrarenal duplicated Inferior vena cava with azygos continuation draining at the superior vena cava. The left renal vein continues upwards replacing the hepatic segment of IVC draining the hepatic veins and the accessory right inferior hepatic vein till the right atrium. Unfortunately, the venous phase is not available and wasn't performed.
Case Discussion
There is incidental identification of accessory right inferior hepatic vein which is a normal variant of hepatic veins, being the most common. It drains the posterior part of the right lobe (mainly segments VI and VII) directly into the inferior vena cava. Other venous variants shown are the infrarenal duplicated Inferior vena cava and azygos continuation.
The dilated pulmonary artery could suggest pulmonary hypertension justifying dyspnea along with possible infection, further echocardiography was recommended.
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