We present a case of a 54 years old male who initially presented with one month history of worsening epigastric pain and vomiting. He was referred to our care after an ultrasound and CT abdomen showing dilated common bile duct up to 13mm with no obvious intraductal obstruction. An incidental type 1 duplicated IVC was demonstrated on the CT abdomen (Figure and 2).\nNo intra-abdominal mass or lymphadenopathy were detected. Notably, he is a known BRCA2 mutation carrier. Both, his mother and sister had BRCA2-positive breast cancer. One of his great uncles also had male breast cancer. The patient was clinically jaundiced on presentation, with a bilirubin of 106. His other liver function tests were ALT at 465, GGT at 1032 and at ALP 271. His tumour markers CA-125 and CA-199 were 12 and 94 respectively.\nThe patient was subsequently found to be hypotensive and tachycardic with a new drop in haemoglobin from 100 to 72 during his stay. An urgent gastroscopy then revealed a 10mm punched-out ulcer with adherent clot at the ampulla. The lesion was partially obstructed and no active bleeding was seen. Histology on biopsy showed moderately differentiated adenocarcinoma. CT angiography was then performed. No active extravasation was seen and the gastroduodenal artery was empirically embolised with microcoils. An apparent cavitation at the medial aspect of the second part of duodenum was now identified on the CT imaging (Figure ). No metastasis was seen on staging CT imaging.\nA whipple procedure was performed. The duplicated right IVC was visualised intraoperatively with mobilisation of the uncinate process but appeared relatively normal. The left sided IVC was not encountered. No major complications were reported during his inpatient stay. Patient was discharged home and subsequently commenced on adjuvant therapy.
A 48-year-old male patient underwent surgical correction of interrupted CoA at the age of 22 years using EABG from the LSCA to the descending aorta. He presented with shortness of breath. The patient was found to be hypertensive with a BP of 170/90 mmHg on both arms. The BP in the lower limbs was 125/85 mmHg with obvious brachiofemoral delay. The patient was taking amlodipine 10 mg and valsartan 160 mg, both once a day. The ECG revealed LV hypertrophy. His TTE revealed normal LV systolic function, with LV hypertrophy and impaired relaxation. A CT angiography revealed stenosis at the proximal anastomosis site of the EABG (Figure ).\nThe plan was to proceed with cardiac catheterization and stenting the proximal stenosis after measuring the gradient but the patient refused any kind of intervention. The patient was sent home after adding a third antihypertensive medication, which wass bisoprolol 5 mg once a day. After six months, the patient's symptoms improved and his BP was 145/80 mmHg. His repeated TTE revealed no major changes.