CTICasesAzygos Continuation of the IVC with Bilateral Hyparterial Bronchi and Polysplenia-like Anatomy
Imaging findings
A subtly malpositioned central catheter prompts closer review of prior imaging, which shows a markedly dilated azygos vein carrying flow into the SVC with interruption of the hepatic segment of the IVC (azygos continuation), a persistent left SVC draining into the coronary sinus, bilateral hyparterial bronchi (each mainstem bronchus lying inferior to its accompanying pulmonary artery), and an unusually lobulated spleen suggestive of a polysplenia-like configuration.
Key takeaways
Recognizing one congenital vascular anomaly -- here, azygos continuation of the IVC discovered incidentally via a catheter course -- should prompt a systematic search for associated anomalies, since bilateral hyparterial bronchi and polysplenia-type splenic morphology cluster together with venous anomalies in the heterotaxy/splenic spectrum, even when the constellation doesn't cleanly fit the traditional polysplenia or asplenia framework.
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