INFRAHEPATIC INTERRUPTION OF THE INFERIOR VENA-CAVA WITH AZYGOS CONTINUATION - A POTENTIAL MIMICKER OF AORTIC PATHOLOGY

Infrahepatic interruption of the inferior vena cava (IVC) with azygos or hemiazygos continuation is a rare finding. Ire this anatomic entity , the intrahepatic segment of the IVC is absent, and the hepatic veins empty directly into the right atrium. Venous blood flow from the lowe r body is directed from the IVC into time azygos system at the level o f the renal veins, with resultant dilation of the azygos and/or hemiaz ygos veins. Because these enlarged vessels lie parallel to the descend ing thoracic aorta, they may be mistaken for aortic pathology (dissect ion, aneurysm, or rupture) during transesophageal echocardiography (TE E). We describe a case of azygos continuation of the NC initially misd iagnosed by TEE as partial aortic rupture. Repeat TEE with intravenous agitated saline injection correctly identified the condition, and the echocardiographic features are described.