Alkashkari W, Al-Husayni F, Althobaiti M, Omeish A, Alqahtani SA Jr.Cureus. 2020 May 19;12(5):e8204. doi: 10.7759/cureus.8204.PMID: 32455092 Free PMC article.
We describe a case of a 17-year-old male patient who was admitted to the hospital for an evaluation of his recurrent postprandial abdominal pain and fatigue on exertion. He was discovered to have severe post-ductal aortic coarctation (CoA) and uninterrupted left-sided inferior vena cava (IVC) draining into the right atrium crossing anterior to the abdominal aorta. There were no signs of IVC compression. Patient symptoms improved dramatically after CoA stenting on follow up. The presence of uninterrupted left-sided IVC in this particular case created a diagnostic dilemma, and it was of great importance to know such anomaly before the procedure. This association of uninterrupted left-sided IVC with CoA is unusual, and to our knowledge, our case is the first to report such congenital association.
Figure 1. Electrocardiogram showing sinus rhythm and left ventricular hypertrophy.
Figure 2. Chest X-ray showing classic rib-notching (red arrow).
Figure 3. Parasternal long axis view showing bicuspid aortic valve and dilatation of ascending aorta.
Figure 4. (A) Echocardiography showing post-ductal aortic coarctation with peak systolic gradient of 80 mmHg. (B) Doppler of the abdominal aorta showing continues diastolic flow.
Figure 5. Three-dimensional volume rendering computed tomography of the aorta showing severe aortic coarctation (red arrow) and collaterals (yellow arrows).
Figure 6. Three-dimensional volume rendering computed tomography showing the course of the left-sided inferior vena cava (red arrow).
Figure 7. (A) Angiogram showing severe aortic coarctation (red arrow) and extensive collaterals (yellow arrow). (B) Angiogram showing post-coarctation stenting.