Presentation
Presented to the emergency department with complain of acute epigastric pain radiating to back since 2 days. Emergency Ultrasound of abdomen revealed subtle altered echotexture of pancreas with peripancreatic inflammatory changes. Serum Lipase (6,000 units/L) and serum amylase (5,455 units/L) were elevated. A diagnosis of Acute pancreatitis was made and Contrast enhanced CT of abdomen was advised for staging.
Patient Data
Axial sections of venous phase of CT abdomen and pelvis showing bulky tail of pancreas with differential enhancement of tail and head of pancreas associated with peripancreatic fat stranding,ill defined collection and thickening of bilateral Gerota's and lateroconal fascia consistent with Acute pancreatitis. Incidentally noted is a rare anatomical variant of Double retro-aortic left renal vein (RA-LRV). The two RA-LRV are defined as superior and inferior RA-LRV. Superior RA-LRV is seen coursing horizontally posterior to aorta at the level of L2 vertebral body and Inferior RA-LRV is seen passing obliquely at the level of L4 vertebral body posterior to aorta to join IVC.
Case Discussion
Double RA-LRV is rarely reported anatomical variant that may present with left pelvis congestion. Embryologically in these cases, there is persistence of left sub-supracardinal anastomosis, the inter-supracardinal anastomosis, the left ventral renal vein and left supracardinal vein. A knowledge of this variant is essential during retroperitoneal surgeries, iatrogenic injuries and the fact that it may present with vascular compression and related hemodynamic problems.
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