下腔靜脈先天性異常的電腦斷層診斷

Computed Tomography-Congenital Anomalies of the Inferior Vena Cava

陳坤煌(K. H. Chen) ； 王家槐(J. H. Wang) ； 周宜宏(Y. H. Chou) ； 刁翠美(C. M. Tiu) ； 張晉民(J. M. Chang) ； 姜仁惠(J. H. Chiang) ； 楊建芳(C. F. Yang) ； 張遵(T. Chang)

《中華放射線醫學雜誌》 11卷1期 (1986/03) Pp. 37-48

摘要

下腔靜脈之先天性異常一般缺乏臨床症狀，多為其他原因受檢查而意外發現者。電腦斷層(CT)目前廣受應用於腹、胸部之檢查，因其優越的空間解像力，下腔靜脈先天異常之發現間有零星之個案報告。榮民總醫院放射線部自民國73年10月至74年12月間經驗過9例下腔靜脈先天異常，概接受過CT檢查。CT可呈示受對比劑顯影增強之血管（靜脈）構造，包括3例雙下腔靜脈，一例雙下腔靜脈伴主動脈後左腎靜脈，其他如腔靜脈後輸尿管，左位下腔靜脈，主動脈後左腎靜脈，腎上段下腔靜脈先天性中斷，肝以下之下腔靜脈先天性缺失等各有一例。因為此等異常伴有明顯側枝循環者並不少見，CT亦能清晰呈示此相伴之變化。9例中之2例另行靜脈攝影術，亦肯定CT之所見。CT對此異常之診斷極為可靠，常可免除進一步的侵襲性檢查或貿然的外科手術。本文並討論下腔靜脈之胚胎演化，先天異常之成因，與其臨床意義。

並列摘要

Patients with congenital anomaly of the inferior vena cava (IVC) usually lack clinical symptoms and signs. Their discovery is usually accidental during other examinations. Computed tomography (CT) is widely used in the examination of the thorax and abdomen. With its good spatial resolution cases of congenital IVC anomalies were discovered by CT examination in the Department of Radiology in VHG from October 1984 to December 1985. CT scan demonstrates the venous structures clearly after contrast enhancement. The nine cases of congenital anomaly include: three case of double IVC; one case with double IVC and left side retroaortic renal vein; retrocaval ureter; left side inferior vena cava; retroaortic left renal vein; absence of the suprarenal IVC; absence of the infrahepatic IVC. The collateral circulation accompanying this anomaly is frequent and thence can be clearly demonstrated by CT as well. Two patients were confirmed by inferior veno-cavo-graphy. CT is highly reliable in diagnosing this kind of anomaly and further invasive examination or surgery can be prevented. The em-embryology of IVC, causes of congenital anomaly and their clinical significance are discussed.