A 14-month-old female was referred to our hospital with a history of an enlarging abdominal mass noted by her parents for 3 days. Physical examination revealed an abdominal mass with clear and smooth margins extending from the right upper quadrant to the right hemipelvis. Routine blood tests were normal apart from mild anaemia and urine analysis did not show hematuria. Ultrasonography of the abdomen revealed a unilateral 10.8 × 7.2 × 9.2 cm solid tumor in the right kidney, whereas the contralateral kidney was normal. Computed tomography (CT) revealed a large lesion arising from the inferior aspect of the right kidney, occupying the right flank and extending across the midline. Enhanced CT detected duplication of IVC below the renal veins and compression and displacement of the right IVC caused by the enormous tumor (Fig. ). An additional movie file shows this in more detail [see Additional file ].\nNeither intravascular extension nor invasion to adjacent organs and regional lymph nodes was detected by CT. Chest radiography was reported normal.\nWith the presumptive diagnosis of WT, a right-sided radical nephrectomy was performed. Final pathology was consistent with favorable histology, stromal-predominant (60%) WT. The renal vessel and IVC were tumor free. The renal hilar and para-aortic lymph nodes were also free from tumor and the final pathological stage was Stage I. According to the regimen of the National Wilms’ Tumor Study Group 5, the patient received postoperative chemotherapy with dactinomycin and vincristine. CT imaging at 3 months postoperatively showed no evidence of residual or recurrent disease. Interestingly, the right IVC played a dominant role and the left IVC seemed to disappear in postoperative enhanced CT (Fig. ). An additional movie file shows this in more detail [see Additional file ]. During the follow-up of 18 months, no local recurrence or metastasis has been observed.
A 46-year-old lady underwent CT chest abdomen and pelvis for breast cancer staging. The CT was reported as free of secondary pathology; however, the below-discussed findings were observed.\nThe CT scan shows the infrarenal tract of the IVC localised on the left side of the aorta. This left paramedian IVC is of normal calibre and crosses the middle line at the level of the celiac trunk, behind the aorta (). At T 12, the IVC continues its way up to the chest as Azygos vein, passing through the aortic hiatus of the diaphragm. No embryologic remnants of the supracardinal veins are noted on the right side of the aorta. A large vein is located ventromedially to the ureter on both sides, consistent with large ovarian veins. Furthermore, the right renal vein follows an anomalous course, as it is situated posteriorly to the aorta to drain into the left-sided IVC. Finally, a partial duplication of the left ureter is noted ().