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J Zhejiang Univ (Med Sci)  2019, Vol. 48 Issue (4): 446-452    DOI: 10.3785/j.issn.1008-9292.2019.08.16
    
Ultrasound diagnosis of left inferior vena cava and double inferior vena cava in fetus
ZHANG Ziwei(),WANG Junmei*()
Department of Ultrasonography, Women's Hospital, Zhejiang University School of Medicine, Hangzhou 310006, China
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Abstract  

Objective: To evaluate the application of ultrasonography in prenatal diagnosis of left inferior vena cava and double inferior vena cava in fetus. Methods: The clinical data and ultrasonographic findings of the fetuses with left inferior vena cava (18 cases) or double inferior vena cava (16 cases) were retrospectively analyzed. Results: The ultrasonographic images of left inferior vena cava showed that in the transverse view of the fetal upper abdomen the inferior vena cava and abdominal aorta were in the normal position; below the level of the hilum, the inferior vena cava was located behind the left side of the abdominal aorta; at the level of the hilum, it crossed the front of the abdominal aorta and run diagonally to the upper right, forming the right inferior vena cava and finally entered into the right atrium. The ultrasonographic images of double inferior vena cava showed that in the transverse view of the fetal lower abdomen, in front of spine there were three transections of blood vessels; in coronal plane of abdomen, the veins run on both sides of the abdominal aorta and entered to the iliac vein of the same side. In 34 cases of abnormal inferior vena cava, there were 17 cases complicated with other system abnormalities, including 13 cases of cardiac anomalies. Conclusions: The left inferior vena cava and double inferior vena cava have characteristic imaging findings, and prenatal diagnosis can be made with ultrasonography. This type of congenital deformity is frequently complicated with other system abnormalities, which should be excluded in fetus, especially for heart system.



Key wordsUltrasonography, prenatal      Ultrasonography, doppler, color      Vena cava, inferior/abnormalities      Vena cava, inferior/diagnostic imaging      Congenital abnormalities     
Received: 04 April 2019      Published: 30 October 2019
CLC:  R714.5  
  R715  
Corresponding Authors: WANG Junmei     E-mail: 5516041@zju.edu.cn;wangjmxin@zju.edu.cn
Cite this article:

ZHANG Ziwei,WANG Junmei. Ultrasound diagnosis of left inferior vena cava and double inferior vena cava in fetus. J Zhejiang Univ (Med Sci), 2019, 48(4): 446-452.

URL:

http://www.zjujournals.com/med/10.3785/j.issn.1008-9292.2019.08.16     OR     http://www.zjujournals.com/med/Y2019/V48/I4/446


胎儿期超声诊断左位下腔静脉及双下腔静脉

目的: 总结胎儿期左位下腔静脉及双下腔静脉的超声声像图特征。方法: 回顾性分析于浙江大学医学院附属妇产科医院行超声检查显示左位下腔静脉(18例)和双下腔静脉胎儿(16例)的临床资料及超声图像表现,总结其特征。结果: 左位下腔静脉超声表现为胎儿上腹部横切面下腔静脉和腹主动脉位置表现正常,即下腔静脉位于腹主动脉右前方;而于肾门水平下方下腔静脉位于腹主动脉左后方,于肾门水平跨越腹主动脉前方,向右上方斜行,形成右侧的下腔静脉,最后流入右心房。双下腔静脉超声表现为胎儿下腹部横切面脊柱前方见三根血管横断面。腹部冠状切面腹主动脉两侧均见静脉伴行,并均延续自同侧髂静脉。34例下腔静脉异常胎儿中,合并其他系统异常17例,其中心脏异常13例。结论: 左位下腔静脉和双下腔静脉有典型产前超声表现,产前超声容易诊断。左位下腔静脉和双下腔静脉常合并其他系统异常(尤其是心脏畸形),须仔细排查。


关键词: 超声检查, 产前,  超声检查, 多普勒, 彩色,  腔静脉, 下/畸形,  腔静脉, 下/影像诊断,  先天畸形 
Fig 1 The shapes of the inferior vena cava on different sections
Fig 2 Ultrasonography of left inferior vena cava
序号 年龄(岁) 孕周(周) 超声表现 合并症状 预后
1 40 25+ 胎儿下腔静脉在肾水平跨过腹主动脉前方位于腹主动脉右前方,肾水平下方位于腹主动脉左侧 存活
2 43 24+ 同病例1 存活
3 31 26+ 同病例1 存活
4 32 30+ 同病例1 存活
5 38 25+ 同病例1 存活
6 26 29+ 同病例1 存活
7 29 24+ 同病例1 存活
8 26 30+ 同病例1 存活
9 31 29+ 同病例1 存活
10 28 26+ 同病例1 存活
11 28 25+ 下腹部横切面下腔静脉走行于腹主动脉左前方,于肾脏水平跨过腹主动脉前方,走行于腹主动脉右前方,室间隔回声中断,见穿隔血流 室间隔缺损 存活
12 36 23+ 同病例11 室间隔缺损 存活
13 31 23+ 同病例11 室间隔缺损 存活
14 31 32+ 胎儿脐静脉腹内段弯向胃泡侧,肾门水平以下下腔静脉位于腹主动脉左侧 胎儿持续性右脐静脉 存活
15 24 23+ 胎儿十字交叉消失,仅见一组开放的房室瓣,主动脉较窄;下腔静脉肾水平以上位于腹主动脉右前方,肾水平以下位于腹主动脉左侧 1.完全性心内膜垫缺损; 2.左心发育不良; 3.主动脉弓缩窄; 4.左位下腔静脉 引产
16 44 23+ 下腔静脉位于腹主动脉左侧,至肾脏水平跨越腹主动脉至右侧;心脏室间隔回声中断,见穿隔血流,双手呈“叠指状”;膀胱水平仅探及一侧脐动脉,脐带腹壁插入处见偏强回声向外膨出,表面见脐带包绕;胎儿颅中线回声中断,双侧脑室相通,丘脑融合;颈后软组织增厚 1.全前脑; 2.脐膨出; 3.室间隔缺损; 4.双手叠指; 5.颈部软组织增厚; 6.单脐动脉
17 21 24+ 胎儿下腔静脉位于腹主动脉左侧,下腔静脉肝内段缺如,经半奇静脉引流后汇入左上腔静脉;胎儿冠状静脉窦扩张,三血管平面显示肺动脉左侧见一血管经扩张冠状静脉窦入右房 1.永存左上腔静脉; 2.左下腔静脉离断伴半奇静脉连接
18 28 23+ 胎儿左房内见三根肺静脉入左房;冠状静脉窦扩张,三血管平面显示肺动脉左侧见一血管经扩张冠状静脉窦入右房;三血管平面探及主动脉弓位于气管右侧;主动脉走行僵硬;下腔静脉位于腹主动脉左侧,于肾水平越过腹主动脉,汇入右房;左肺动脉起自主肺动脉右侧 1.永存左上腔静脉; 2.右位主动脉弓; 3.室间隔缺损; 4.左位下腔静脉; 5.主动脉弓内径偏窄; 6.心律失常 不详
Tab 1 Ultrasound and clinical manifestations of 18 cases of left inferior vena cava fetus
Fig 3 Ultrasonography of double inferior vena cava
序号 年龄(岁) 孕周(周) 超声表现 合并症状 预后
1 30 26+ 腹部横切面显示腹主动脉两侧各见一血管伴行,左侧血管于肾脏水平跨腹主动脉前方与右侧血管汇合入右房 存活
2 33 30+ 同病例1 存活
3 44 25+ 同病例1 存活
4 41 23+ 同病例1 存活
5 25 24+ 同病例1 存活
6 31 25+ 同病例1 存活
7 29 26+ 同病例1 存活
8 31 24+ 胎儿冠状静脉窦扩张,三血管平面显示肺动脉左侧见一血管回声经扩张冠状静脉窦入右房,腹主动脉两侧均可见下腔静脉回声 永存左上腔静脉 存活
9 24 25+ 三血管气管平面,主动脉弓、动脉导管弓呈“U”字形,主动脉弓位于气管右侧,主动脉弓上见三个分支,第一根考虑左无名动脉,第二根考虑右颈总动脉,第三根动脉考虑右锁骨下动脉;肾门水平腹主动脉左右两侧各见一根下腔静脉,左侧较细 1.右位主动脉弓伴镜像分支; 2.室间隔缺损
10 44 23+ 房、室间隔回声中断,见一组房室瓣启闭,瓣口见反流信号,腹腔横切面显示主动脉两侧各见一血管伴行,左侧血管于肾上极水平跨过腹主动脉前方,与右侧血管汇入右房 1.完全心内膜垫缺损;2.主动脉弓缩窄 引产
11 18 24+ 胎儿心脏位于右侧胸腔,心尖朝右,心房反位,心室左袢,心脏十字交叉回声中断,仅见一组房室瓣,见两组大血管均由右室发出平行走向。三血管切面见左上腔静脉、主动脉、右肺动脉,主动脉位于气管右侧 1.右旋心;2.心内膜垫缺损;3.大血管异常(右室双出口合并肺动脉狭窄);4.右肺动脉起源主动脉;5.右位主动脉弓
12 31 24+ 胎儿室间隔回声中断,见穿隔血流,主动脉前移增宽骑跨于室间隔上,肾门水平腹主动脉左右侧均见下腔静脉,左侧下腔静脉于肾门上方汇入右侧下腔静脉 法洛四联症
13 43 23+ 胎儿肾脏水平下方腹主动脉两侧均见一支静脉血管,左侧跨腹主动脉汇入右侧,于肾脏水平汇合形成一支下腔静脉,室间隔回声中断,见穿隔血流;胎儿脊柱骶尾部排列紊乱 1.室间隔缺损; 2.脊柱裂 引产
14 27 24+ 右肺偏小,回声未见异常,心脏右移,胸腔未见明显胸腺回声,双肾于脊柱前方呈“C”形,肝脏回声增粗,脐静脉直接汇入右心房,未见明显导管回声。膀胱水平仅见一条脐动脉,脐带横断面呈“吕”字形 1.右肺发育不良; 2.静脉导管缺如; 3.胸腺发育不良; 4.肝脏回声改变; 5.融合肾;6.单脐动脉; 7.羊水过多 引产
15 39 24+ 脊柱两侧见左右下腔静脉 出生后肛门闭锁 存活
16 36 29+ 胎儿右肾区未见明显肾脏回声,可见肾上腺“平躺”现象,左肾未见明显异常,可见双下腔回声,左侧下腔静脉与左肾中上极水平跨过降主动脉后汇入右侧下腔静脉 胎儿右肾缺如或发育不良
Tab 2 Ultrasound and clinical manifestations of 16 cases of double inferior vena cava fetus
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