Contributed by
Boston Children's Hospital
Vishesh Jain.
History
1-month-old female infant in the NICU, with a recently placed PICC.
Images (Click any image to enlarge)
Question
What accounts for the unusual course of the PICC within the abdomen?
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Correct answer
Duplicated IVC
Discussion
The PICC courses along the left side of the spine in the lower abdomen rather than the right. The US image shows 3 prevertebral vessels coursing in the craniocaudal axis rather than 2 (aorta and IVC), consistent with a duplicated IVC. This appearance can be seen on any cross-sectional imaging modality (e.g. US, CT, MR). Portions of the renal veins can be seen on the US image, oriented obliquely within the transverse plane toward the IVCs. Left-side IVCs, especially in the setting of duplicated IVC, often join the left renal vein as it crosses to the right to join the right-sided suprarenal IVC.
Differential diagnosis
- Transposed (aka left-sided) IVC
- Non-venous PICC location
Additional images
References
- J. Edward Bass, Michael D. Redwine, Larry A. Kramer, Phan T. Huynh, and John H. Harris, Jr. "Spectrum of Congenital Anomalies of the Inferior Vena Cava: Cross-sectional Imaging Findings." RadioGraphics 2000 20:3, 639-652.