1 0 4 Abril­Junio 2012

Dr. Alberto Emilio Morató López*Dr. Óscar Quiróz Castro**Dr. José Luis Ramírez Arias*

Anomalías congénitas de la vena cava inferior. El rol de la tomografía computada multidetector

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RESUMEN

Introducción.  Las  anoma­/1&4"9+*0E*.(&4",$"/&"8$*&"9&8&".*;$'.+'" VW?2X" 4+*" '$4R/(&,+",$" /&" %$'4.4($*9.&" +" '$0'$4.M*"anormal  de  una  de  las  venas $)L'.+*&'.&4"%'$9R'4+'&4@"7+*"'&'&4" <" 0$*$'&/)$*($" 4+*" U&­//&O0+4".*9.,$*(&/$4"QR$"%R$,$*"(&)L.E*"%&4&'",$4&%$'9.L.,+4@"N&"(+)+0'&;1&"9+)%R(&,&")R/­(.,$($9(+'"V:?H#X"$4"$/")E(+,+",$"$/$99.M*"%&'&"4R",.&0*M4(.9+@Objetivos."-$8.4&'"/&4"9&'&9­

($'14(.9&4"&*&(M).9&4"<"$)L'.+­/M0.9&4F"&41"9+)+"/&4".)%/.9&9.+­*$4"9/1*.9&4"<"QR.'Y'0.9&4",$"/&4"&*+)&/1&4",$"/&"W?2"<",$)+4('&'"/&"R(./.,&,",$"/&":?H#"%&'&"4R"$8&/R&9.M*@Tipos de anomalía de la VCI. 

N+4" %'.*9.%&/$4" 4+*P" &X" 8$*&"'$*&/" .OQR.$',&" '$('+&M'(.9&F" LX"

8$*&" '$*&/" .OQR.$',&" 9.'9R)&­M'(.9&F"9X"",+L/$"W?2".*;'&''$*&/F",X"W?2" .*;'&''$*&/" .OQR.$',&F"$X"9+*(.*R&9.M*" ,$" /&"W?2" 9+*" /&"Z9.0+4" +" U$).Z9.0+4" <" ;X" &R­4$*9.&" ,$" W?2@" ?&,&" R*&" ,$"$4(&4"&*+)&/1&4"(.$*$",.;$'$*($4"(.%+4",$".)%/.9&9.+*$4"9/1*.9&4"<"QR.'Y'0.9&4"QR$".*9/R<$*")&<+'"'.$40+" ,$" ('+)L+4.4" 8$*+4&"%'+;R*,&" <[+" .*4R\9.$*9.&" 8$­*+4&" 9'M*.9&F" '.$40+" %+($*9.&/",$" 9+)%/.9&9.+*$4"$*" 9.'R01&4",$"&L,+)$*"+" (M'&I"<"%R$,$*"+9&4.+*&'"$''+'$4",$",.&0*M4(.9+"$*"%'R$L&4",$".)&0$*@Discusión. =/" ,.&0*M4(.9+"

,$"&*+)&/1&",$"/&"W?2"%$').($"&/")E,.9+"(+)&'"/&4"9+*4.,$'&­ciones pertinentes  de acuerdo 9+*"$/" (.%+" V)+,.\9&9.+*$4" $*"(E9*.9&4" QR.'Y'0.9&4F" $4(R,.+4"9+)%/$)$*(&'.+4F" %'$8$*9.M*",$" ('+)L+4.4" 8$*+4&F" $(9@X@"

N&":?H#",$)R$4('&" &,$9R&­,&)$*($" $4(&4" &*+)&/1&4" &41"9+)+"U&//&O0+4"&4+9.&,+4"9+)+"8Z'.9$4" ,$" &]R$*($4" <[+" ('+)­L+4.4@Conclusión."N&4"&*+)&/1&4"

9+*0E*.(&4",$"/&"W?2"(.$*$*".)­%+'(&*($4".)%/.9&9.+*$4"9/1*.9&4"<"QR.'Y'0.9&4"<"%R$,$*"4$'")+(.­vo de confusión en estudios de .)&0$*F"/+"QR$"U&9$"*$9$4&'.+"4R"9+*+9.).$*(+@"N&":?H#"U&",$)+4('&,+" 4$'" Y(./" <" $\9.$*($"%&'&",.&0*+4(.9&'"&*+)&/1&4",$"/&"W?2"<"%&'&"$8&/R&'"9+)%/.9&­9.+*$4@

Palabras  clave:" &*+)&/1&"9+*0E*.(&F" 8$*&" 9&8&" .*;$'.+'F"( +) + 0 ' & ; 1 & " 9 +)% R ( & , &")R/(.,$($9(+'F"('+)L+4.4"8$*+4&@

Continúa en la pág. 105

ARTÍCULO DE REVISIÓN!"#$%&'(%')#(*+$+,-#'./0*1+'23425264378449:

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)Z(.9&4"<"%+'"$*,$"'$%'$4$*(&*"U&//&O0+4".*9.,$*(&/$4"$*"$4(R,.+4",$":?H#",$/"&L,+)$*`"4.*"$)L&'0+F" /&".)%+'(&*9.&" ,$" .,$*(.\9&'/&4" <" '$%+'(&'/&4" '&,.9&" $*"/&4"%+4.L/$4" .)%/.9&9.+*$4"9/1*.9&4" <"QR.'Y'0.9&4"QR$"%R,.$'&*"($*$'@BFDN&4"&*+)&/1&4",$"/&"W?2"9+*,.9.+*&*")+,.\9&9.+*$4"

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Introducción=I.4($"R*"&)%/.+"$4%$9('+",$"&*+)&/1&4"9+*0E*.(&4"

,$" /&"8$*&"9&8&" .*;$'.+'" VW?2XBFc con una prevalencia 0$*$'&/" $4(.)&,&"$*('$" C@^>C@Dd"$*('$" /&" %+L/&9.M*"4&*&"<",$"U&4(&"cd"$*"%&9.$*($4"9+*"+('&4"&*+)&/1&4"9&',.+8&49R/&'$4@^Fe"=4(&4"&*+)&/1&4"4+*"9+*4.,$'&,&4"$*(.,&,$4"'&'&4`"4.*"$)L&'0+F"9+*"$/"&,8$*.).$*(+",$"/&"*R$8&"($9*+/+01&",$"(+)+0'&;1&"9+)%R(&,&")R/(.,$­($9(+'"V:?H#X"<"&,QR.4.9.M*",$"$4(R,.+4"9+*")$,.+",$"

1 0 5Abril­Junio 2012

Viene de la pág. 104

ABSTRACT

Introduction." ?+*0$*.(&/"&*+)&/.$4"+;"(U$".*;$'.+'"8$*&"9&8&" V2W?X" &'$" (U$" '$4R/(" +;"persistence  or  abnormal  re­0'$44.+*"+;"+*$"+;"(U$"$)L'<+­*.9"%'$9R'4+'" 8$.*4@":U$<"&'$"'&'$"&*,"R4R&//<"&'$".*9.,$*(&/"\*,.*04"(U&(")&<"0+"R**+(.9$,@"HR/(.,$($9(+'"9+)%R($,"(+)+­0'&%U<"VH#?:X".4"(U$")$(U+,"+;"9U+.9$";+'",.&0*+4.4@Objectives. " -$8.$f" (U$"

&*&(+).9&/" &*," $)L'<+/+0.9&/"9U&'&9($'.4(.94F" &4"f$//" &4" (U$"9/.*.9&/"&*,"4R'0.9&/".)%/.9&(.+*4F"+;" 2W?" &*+)&/.$4" &*," %'+8$"(U$" R4$;R/*$44" +;" H#?:" .*"$8&/R&(.*0"(U$)@

Classification.  :U$" )+4("9+))+* " 2W? " 9+*0$* . ( & /"&*+)&/.$4" &'$P  " &X" '$('+&+'(.9"/$;(" '$*&/" 8$.*F" LX" 9.'9R)&+'(.9"/$; ( " '$*&/ " 8$.*F " 9X " ,+RL/$".*;'&'$*&/"2W?F",X"/$;(".*;'&'$*&/"2W?F"$X"9+*(.*R&(.+*"+;"2W?"f.(U"&O<0+4" +'" U$).&O<0+4" 8$.*F"&*,";X"&L4$*9$"+;"2W?@"=&9U"+;"(U$4$" &*+)&/.$4" U&4" ,.;;$'$*("g.*,4" +;" 9/.*.9&/" &*," 4R'0.9&/".)%/.9&(.+*4F" fU.9U" .*9/R,$"0'$&($'" '.4g" +;" ,$$%" 8$*+R4"(U'+)L+4.4" &*,[+'" 9U'+*.9"8$*+R4" .*4R;;.9.$*9<" &*," (U$"%+($*(.&/" '.4g" +;" 9+)%/.9&(.+*4".*"&L,+).*&/"+'"9U$4("4R'0$'.$4"&*," )&<" 9&R4$" ,.&0*+4(.9"$''+'4".*".)&0$"($4(4@Discussion.   #.&0*+4.4"

+;" 2W?" &*+)&/.$4" &//+f4" (U$",+9(+'" (+" (&g$" (U$" %$'(.*$*("9+*4.,$'&(.+*4" L&4$," +*" (U$"

(<%$" V)+,.\9&(.+*4" .*" 4R'0.9&/"($9U*.QR$4F" 9+)%/$)$*(&'<"4(R,.$4F" %'$8$*(.+*" +;" 8$*+R4"(U'+)L+4 .4 F " $ (9 @ X @ " H#?:"$ ; ; $ 9 ( . 8 $ / < " 4 U+f4 " 4 R 9U"&*+)&/.$4F"&4"f$//"&4"&44+9.&($,"; .*,.*04" 4R9U" &4" 8&'.9+4$"('.LR(&'.$4"&*,[+'"(U'+)L+4.4@Conc lus ion .   Because 

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Key  words: " 9+*0$*. (& /"&*+)&/<F" .*;$'.+'" 8$*&" 9&8&F"mu l t i d e t e c t o r   c ompu t ed (+)+0'&%U<F"8$*+R4"(U'+)L+4.4@

K/0R*&4",$"$4(&4"&*+)&/1&4")+4('&'+*" 4$'" ;&9(+'",$"'.$40+"%&'&",$4&''+//&'"('+)L+4.4"8$*+4&"%'+;R*,&F"%'.*9.%&/)$*($" $*" /&4" 8$*&4" ./1&9&4" <" $*" %&9.$*($4"hM8$*$4@^FBC Las series publicadas indican prevalencias ,$"('+)L+4.4",$"U&4(&"$/"b@Dd@3"J.*&/)$*($F"%R$,$*"4$'")+(.8+",$"9+*;R4.M*"$*"$4(R,.+4",$".)&0$*@BFBBFBc"N&":?H#" 9+*")$,.+" ,$" 9+*('&4($" .*('&8&49R/&'"

'$%'$4$*(&"$/")E(+,+",$",.&0*M4(.9+",$"$/$99.M*"%&'&"$8&/R&'"/&4"&*+)&/1&4",$"/&"W?2",$L.,+"&"4R"&/(&"'$4+/R­9.M*"$4%&9.&/"<"9&%&9.,&,")R/(.%/&*&'FD"&,$)Z4",$"QR$"%$').($",$($9(&'"<"$8&/R&'"9+)%/.9&9.+*$4".*U$'$*($4@3

Objetivosi" -$8.4&'"/&4"9&'&9($'14(.9&4"&*&(M).9&4"<"%+'":?H#"

,$"/+4",.;$'$*($4"(.%+4",$"&*+)&/1&"9+*0E*.(&",$"/&"W?2"U&9.$*,+"E*;&4.4"$*"$/"%'+9$4+"$)L'.+0E*.9+@

i" -$8.4&'"/&4".)%/.9&9.+*$4"9/1*.9&4"QR$"(.$*$"9&,&"(.%+",$"&*+)&/1&",$"/&"W?2@

i" #$)+4('&'"/&"R(./.,&,",$"/&":?H#"%&'&"/&"$8&/R&9.M*",$"/&4"&*+)&/.&4",$"/&"W?2@

Material y métodos7$" '$&/.OM" R*" $4(R,.+" R*.9E*('.9+F" ,$49'.%(.8+F" '$­

('+4%$9(.8+",$" (.%+"4$'.$",$"9&4+4F"9+*4.4($*($"$*" /&"'$9+%./&9.M*",$"$4(R,.+4",$":?H#",$"&L,+)$*"9+*")$,.+",$"9+*('&4($".*('&8&49R/&'F"$*"/+4"QR$"4$"URL.$­'&*".,$*(.\9&,+"&*+)&/1&4",$"/&"8$*&"9&8&".*;$'.+'F"$*"

$/"3+4%.(&/"5*0$/$4",$"6$,'$0&/"$*"$/"%$'.+,+"9+)­%'$*,.,+"$*('$")&'O+",$"cCBC"<";$L'$'+",$"cCBB@"7$"9+''+L+'&'+*"/&4"9&'&9($'14(.9&4"%+'".)&0$*",$"9&,&"(.%+",$"&*+)&/1&",$"/&"W?2"9+*"/&4",$49'.(&4"$*"/&"/.($'&(R'&@

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+9(&8&",$"0$4(&9.M*"$".*8+/R9'&"R*"9+)%/$h+"%'+9$4+",$";+')&9.M*F"'$0'$4.M*"<";R4.M*",$"^"%&'$4",$"8$*&4"$)L'.+*&'.&4" ,$" ,.4%+4.9.M*" /+*0.(R,.*&/@B>^FBc  Estas 8$*&4"4+*P

B@" W$*&4"9&',.*&/$4"%+4($'.+'$4c@" W$*&4"4RL9&',.*&/$4"^@" W$*&4"4R%'&9&',.*&/$4"

N&"8$*&"9&8&".*;$'.+'",$\*.(.8&"$4(Z"9+*;+')&,&"%+'"9R&('+" 4$0)$*(+4" QR$" 4+*F" $*" +',$*" 9$;&/+>9&R,&/P".*('&U$%Z(.9+F"4R%'&''$*&/F"'$*&/"$".*;'&''$*&/"V\0R'&"BX@=/",$4&''+//+"$)L'.+/M0.9+",$"/&"W?2"4$".*.9.&"9+*"/&"

&%&'.9.M*",$"/&"8$*&"8.($/.*&",$'$9U&"QR$"4$"R*$"&/"4$*+"8$*+4+")$,.&/" ,$'$9U+",$/" (RL+" 9&',1&9+" V\0R'&"cXF").4)&"QR$",&'Z"/R0&'"&"/&"%+'9.M*".*('&U$%Z(.9&",$"/&"W?2F"$*"(&*(+"QR$"/&4"8$*&4"8.($/.*&".OQR.$',&"<"R)L.­/.9&/$4"+'.0.*&'Z*"/+4"4.*R4+.,$4"U$%Z(.9+4"<"/&4"8$*&4"4R%'&U$%Z(.9&4@"N&"4$9R$*9.&",$"9&)L.+4"$)L'.+*&'.+4"4$"$4QR$)&(.O&"<",$49'.L$"$*"/&4"\0R'&4"B"&"b@

1 0 6 Abril­Junio 2012

3+4&#(/"($1&)$'5$(/"('$(0"1$(.$0$(+12"%+&%j*&" &*+)&/1&" ,$" /&" W?2" '$]$h&" R*&" '$0'$4.M*" +"

%$'4.4($*9.&" &*+')&/" ,$" /&4" 8$*&4"$)L'.+*&'.&4@"7$"%R$,$*"%'+,R9.'")R9U&4"8&'.&9.+*$4"$*"4R"9+*\0R'&­9.M*"&*&(M).9&@BFcFBc"N&4"%'.*9.%&/$4"4+*P

>" W$*&"'$*&/".OQR.$',&"'$('+&M'(.9&>" W$*&"'$*&/".OQR.$',&"9.'9R)&M'(.9&">" #+L/$"W?2".*;'&''$*&/">" W?2".*;'&''$*&/".OQR.$',&>" ?+*(.*R&9.M*",$"/&"W?2"9+*"/&"Z9.0+4"+"U$).Z9.0+4">" KR4$*9.&",$"W?2"

Vena vitelinaderecha

V. subcardinal

V. supracardinal

Ácigos Hemiácigos

V. cardinal posterior

Segmentos de la VCI

Intrahepático

Suprarrenal

Renal

Infrarrenal

Aorta

Conductos de Couvier Vena umbilical derecha Vena vitelina derecha 

Bulbo arterial  

Ventrículo primitivo  

Aurícula primitiva  

Senos venosos  

Figura 1."7$0)$*(+4",$"/&"8$*&"9&8&".*;$'.+'

Figura 2."=/" (RL+"9&',1&9+@"N+4"9+*,R9(+4",$"?+R8.$'",$­'$9U+4" ;+')&*" %&'($" ,$/" 4.4($)&"Z9.0+4@"=/" 4$*+" 8$*+4+".OQR.$',+"4$"U.%+('+\&"%&'&"9+*8$'(.'4$"$*"$/"4$*+"9+'+*&'.+@

Vena vitelinaderecha

V. subcardinal

V. cardinal posterior

Vena vitelinaderecha

V. subcardinal

V. cardinal posterior

Figura 3."K%&'.9.M*",$"/&4"8$*&4"9&',.*&/$4"%+4($'.+'$4"<",$"/&4"4RL9&',.*&/$4@"N&4"8$*&4"9&',.*&/$4",$4$)L+9&*"$*"/+4"9+*,R9(+4",$"?+R8.$'F"$I9$%(+"/&"4RL9&',.*&/",$'$9U&"QR$"4$"9+*$9(&"&"/&"8$*&"8.($/.*&",$'$9U&"QR$",'$*&",.'$9(&)$*($"$*"$/"4$*+"8$*+4+@

Figura  4." J+')&9.M*" ,$" &*&4(+)+4.4" ('&*48$'4&4" .*($'>4RL9&',.*&/"<"%+4($'+9&',.*&/>4RL9&',.*&/$4@"N&4"8$*&4"9&'­,.*&/$4",$4$)L+9&*"$*"/+4"9+*,R9(+4",$"?+R8.$'F"$I9$%(+"/&"4RL9&',.*&/",$'$9U&"QR$"4$"9+*$9(&"&"/&"8$*&"8.($/.*&",$'$9U&"QR$",'$*&",.'$9(&)$*($"$*"$/"4$*+"8$*+4+@

Vena renal izquierda retroaórtica=*"$4(&"&*+)&/1&"/&"8$*&"'$*&/".OQR.$',&"$4"Y*.9&"

<"(.$*$"('&<$9(+"'$('+&M'(.9+"V\0R'&"BCX@"7$",$L$"&"/&"%$'4.4($*9.&",$"/&"8$*&".*($'4R%'&9&',.*&/"9+*"'$0'$4.M*",$"/&".*($'4RL9&',.*&/@"7$",+9R)$*(M"R*&"%'$8&/$*9.&",$"U&4(&"^@ed@BFB^"6R$,$"$I.4(.'" 9+)%'$4.M*",$"$4(&"8$*&"&L$''&*($"$*('$"/&"&+'(&"<"/&"9+/R)*&"8$'($L'&/@"

1 0 7Abril­Junio 2012

3&"4.,+"'$9+*+9.,&"9+)+"R*";&9(+'"$(.+/M0.9+"%&'&"$/",$4&''+//+",$"8&'.9+9$/$F14"<"$*"9&4+4"4$8$'+4"%R$,$"9+*,.9.+*&'"R*"41*,'+)$",$"k9&49&*R$Ol"9+*"8Z'.9$4"%$'.R'$($'&/$4F"U$)&(R'.&F"8&'.9+9$/$"<"9+*0$4(.M*"8$­*+4&"%E/8.9&".OQR.$',&@BFb"N&":?H#F"&,$)Z4",$",$($9(&'"/&"&*+)&/1&F")R$4('&"/+4"9&)L.+4"8&49R/&'$4",$"$4($"41*,'+)$"/+"QR$"&R*&,+"&"/&"9/1*.9&"%$').($"$4(&L/$9$'"$/",.&0*M4(.9+"V\0R'&"BCF".)Z0$*$4"B&"<"BLX@

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Ácigos Hemiácigos

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1 0 9Abril­Junio 2012

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