Double inferior vena cava mimicking lymphadenopathy.

A 78-year-old man with no antecedent pathology presented with deterioration of his general state of health and 8-month history of urinary symptoms (frequent daytime urination, difficulty in starting urination, dribbling of urine, and decreased force of urinary stream). Physical examination showed a slim man (BMI 19 kg/m2) with dry and wrinkled skin. Digital rectal examination revealed an enormously enlarged, hard, irregular prostate. Urine test detected microscopic hematuria. Prostate-specific antigen was high (18 ng/mL). Ultrasonography confirmed the diagnosis of an enormous heterogeneous prostate and revealed a left paraaortic ‘adenopathy’ measuring 2 cm. Axial angio-CT scan, however, suggested that the paraaotic mass was due to vena cava developmental anomaly (Figure 1). Coronal CT scan reconstruction revealed a double inferior vena cava (IVC) (Figure 2), with right and left branches lying alongside a calcified abdominal aorta.

Figure 1

Axial abdominal angio-CT scan shows the abdominal aorta surrounded by the right inferior vena cava (arrowhead) and a similar left formation (arrow), suggesting an abnormality of vena cava development.

Figure 2

Coronal abdominal CT scan with reconstruction shows the inferior vena cava with right (arrowhead) and left (arrow) branches. Note the enormous prostate (star).

Embryogenesis of the IVC is a complex process involving the development, regression, anastomosis, and replacement of three pairs of embryonic veins (posterior cardinal, subcardinal, and supracardinal veins). A double IVC is a rare congenital anomaly (with an incidence of 0.2% to 3%) and is mostly related to failure of regression of the left supracardinal vein.1 Radiologically, the presence of a double IVC can be mistaken for a pathological lesion such as lymphadenopathy or left pyeloureteric dilatation.12 A double IVC should be recognized as it can have significant clinical implications, especially during retroperitoneal surgery or in the treatment of thromboembolic diseases.3