Anomalías congénitas de la vena cava inferior. El rol de la

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ARTÍCULO DE REVISIÓN
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
RESUMEN
Introducción. Las anoma­
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,$" /&" %$'4.4($*9.&" +" '$0'$4.M*"
anormal de una de las venas $)L'.+*&'.&4" %'$9R'4+'&4@" 7+*"
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(.,$($9(+'"V:?H#X"$4"$/")E(+,+"
,$"$/$99.M*"%&'&"4R",.&0*M4(.9+@
Objetivos."-$8.4&'"/&4"9&'&9­
($'14(.9&4"&*&(M).9&4"<"$)L'.+­
/M0.9&4F"&41"9+)+"/&4".)%/.9&9.+­
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/&"R(./.,&,",$"/&":?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"
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$4(&4"&*+)&/1&4"(.$*$",.;$'$*($4"
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QR.'Y'0.9&4"QR$".*9/R<$*")&<+'"
'.$40+" ,$" ('+)L+4.4" 8$*+4&"
%'+;R*,&" <[+" .*4R\9.$*9.&" 8$­
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,$" 9+)%/.9&9.+*$4" $*" 9.'R01&4"
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+9&4.+*&'"$''+'$4",$",.&0*M4(.9+"
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Discusión. =/" ,.&0*M4(.9+"
,$"&*+)&/1&",$"/&"W?2"%$').($"
&/")E,.9+"(+)&'"/&4"9+*4.,$'&­
ciones pertinentes de acuerdo 9+*" $/" (.%+" V)+,.\9&9.+*$4" $*"
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?+''$4%+*,$*9.&"#'@"K/L$'(+"H+'&(M"NM%$O@"?+''$+"$/$9('M*.9+P"QR.QR$S)/&TU+()&./@9+)
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/(.,$­
($9(+'"V:?H#X"<"&,QR.4.9.M*",$"$4(R,.+4"9+*")$,.+",$"
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8Z'.9$4" ,$" &]R$*($4" <[+" ('+)­
L+4.4@
Conclusión."N&4"&*+)&/1&4"
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vo de confusión en estudios de .)&0$*F"/+"QR$"U&9$"*$9$4&'.+"
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Palabras clave:" &*+)&/1&"
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Viene de la pág. 104
ABSTRACT
Introduction." ?+*0$*.(&/"
&*+)&/.$4"+;"(U$".*;$'.+'"8$*&"
9&8&" V2W?X" &'$" (U$" '$4R/(" +;"
persistence or abnormal re­
0'$44.+*"+;"+*$"+;"(U$"$)L'<+­
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+;"9U+.9$";+'",.&0*+4.4@
Objectives." -$8.$f" (U$"
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Material y métodos
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Abril­Junio 2012
105
Ácigos
Hemiácigos
Vena vitelina
derecha
Segmentos de la VCI
Intrahepático
V. subcardinal
Vena vitelina
derecha
V. subcardinal
Suprarrenal
Renal
V. supracardinal
V. cardinal
posterior
Infrarrenal
Aorta
V. cardinal
posterior
Figura 1."7$0)$*(+4",$"/&"8$*&"9&8&".*;$'.+'
Bulbo arterial Ventrículo primitivo Figura 3."K%&'.9.M*",$"/&4"8$*&4"9&',.*&/$4"%+4($'.+'$4"<",$"
/&4"4RL9&',.*&/$4@"N&4"8$*&4"9&',.*&/$4",$4$)L+9&*"$*"/+4"
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$*"$/"4$*+"8$*+4+@
Vena vitelina
derecha
Aurícula primitiva V. subcardinal
Senos venosos Conductos de Couvier Vena umbilical derecha Vena vitelina derecha V. cardinal
posterior
Figura 2." =/" (RL+" 9&',1&9+@" N+4" 9+*,R9(+4" ,$" ?+R8.$'" ,$­
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Figura 6."K('+\&",$"/&4"8$*&4"9&',.*&/$4"%+4($'.+'$4"9+*"$I­
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4R%'&9&',.*&/$4"<"4RL9&',.*&/$4"&"('&8E4",$"/&4"&*&4(+)+4.4@
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$4"
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Figura 8."?+*;+')&9.M*",$/"4$0)$*(+".*;'&''$*&/",$"/&"W?2@"
-$4R/(&" ,$" /&" 9+&/$49$*9.&" $*('$" /&" 8$*&" 4R%'&9&',.*&/" <"
4RL9&',.*&/",$'$9U&4@
Vena renal izquierda circumaórtica
=I.4($*" ,+4" 8$*&4" '$*&/$4" .OQR.$',&4" '+,$&*,+" /&"
&+'(&@" N&" 8$*&" ,$" ('&<$9(+" %+4($'.+'" $4" 9&R,&/" &" /&"
%'$&M'(.9&" V\0R'&" BBF" .)Z0$*$4" c&>c,X@" 7R" +'.0$*" 4$"
debe a la persistencia de las venas intersubcardinal <"/&".*($'4R%'&9&',.*&/@BFB^"7$"9&/9R/&"R*&"%'$8&/$*9.&"
,$" c@e" &" a@Gd@1" 7R" .,$*(.\9&9.M*" $4" '$/$8&*($" %&'&"
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$*"%&'(.9R/&'"$*";&4$4"&'($'.&/"<"8$*+4&F"$4"&/(&)$*($"
efectiva para elaborar el mapeo vascular renal e iden­
(.\9&'" 8&'.&*($4@B_" #$" .0R&/" )&*$'&" %R$,$" &4+9.&'4$"
Abril­Junio 2012
107
Vena vitelina
derecha
Ácigos
Hemiácigos
V. subcardinal
V. supracardinal
Figura 9."W?2",$\*.(.8&@"N&4"8$*&4"9&',.*&/$4"QR$"*+";+')&*"
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QR$"R/($'.+')$*($"+'.0.*&*"$/"4.4($)&"Z9.0+4>U$).Z9.0+4@
Imagen 1."V&X"#.;$'$*($4"$4(R,.+4",$":?H#"9+*"9+*('&4($"
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(.%+" ,$" &*+)&/1&" $4" 9&R4&" ;'$9R$*($" ,$" 8&'.9+9$/$"
'$9.,.8&*($@BGFBb
Figura 10."W$*&"'$*&/".OQR.$',&"'$('+&M'(.9&@
9+*" 41*,'+)$" ,$" k9&49&*R$Ol@BFBCFBG" n+9" o" <" 4R4" 9+­
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$4(&,14(.9&"4.0*.\9&(.8&"$*('$"/&"%'$4$*9.&",$"&/0Y*"(.%+"
1 0 8 Abril­Junio 2012
Doble vena cava inferior
=I.4($*",+4"8$*&4"9&8&4"&"/+4"/&,+4",$"/&"&+'(&"&L,+­
).*&/@"N&"W?2".OQR.$',&"4$"R*$"&"/&"8$*&"'$*&/".%4./&($'&/"
<",$4$)L+9&"$*"/&"W?2",$'$9U&"4R%'&''$*&/BFc"V\0R'&"BcF"
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,$".)&0$*"4$99.+*&/F"9+*"&,$*+%&(1&4"%&'&&M'(.9&4F"$4­
%$9.&/)$*($"4."$/"'$;+'O&).$*(+"%+49+*('&4($".*('&8$*+4+"
$4"%+L'$"%+'"'&O+*$4"(E9*.9&4"+"('+)L+4.4@cCFcB En caso ,$".*,.9&9.M*",$"\/('+",$"/&"W?2"4$"'$QR$'.'Z""9+/+9&9.M*"
,$",+L/$"\/('+F"R*+"$*"9&,&"W?2@GFcc
Figura 11."W$*&"'$*&/".OQR.$',&"9.'9R)&M'(.9&@
Figura 12."#+L/$"8$*&"9&8&".*;$'.+'@
Imagen 2.":?H#"9+*"9+*('&4($".*('&8$*+4+"$*";&4$"8$*+4&F"4$"+L4$'8&*",+4"8$*&4"'$*&/$4".OQR.$',&4"QR$"'+,$&*"/&"&+'(&"
V]$9U&4X"<"%'+<$99.M*",$")ZI.)&".*($*4.,&,"V,X@"AM($4$"QR$"/&"8$*&"'$('+&M'(.9&"(.$*$"%+4.9.M*")Z4"9&R,&/@
Imagen 3.":?H#",$"&L,+)$*"$*";&4$"8$*+4&",$")&49R/.*+",$"D_"&p+4@"=*"&"<"L"4$"+L4$'8&",+L/$"W?2"&"&)L+4"/&,+4",$"
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Abril­Junio 2012
109
Vena cava inferior izquierda
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/&"&+'(&F"R4R&/)$*($"4$"R*$"&"/&"8$*&"'$*&/".OQR.$',&F"
/&"9R&/",'$*&"&"/&"W?2",$'$9U&"4R%'&''$*&/"V.)Z0$*$4"
e&>e9F"\0R'&"B^X@"=*")R<"'&'+4"9&4+4"U&<"9+*(.*R&9.M*"
$*" /&" U$).Z9.0+4@BFB^" 7$" ,$L$" &" /&" %$'4.4($*9.&" ,$" /&"
8$*&" 4R%'&9&',.*&/" .OQR.$',&" <" '$0'$4.M*" ,$" /&" 8$*&"
4R%'&9&',.*&/",$'$9U&@"N&"%'$8&/$*9.&",$"$4($"(.%+",$"
&*+)&/1&"$4")R<"L&h&P"C@cd"&"C@^d@BFB^"2)%/.9&",.\9R/(&,"
%&'&"9+/+9&9.M*",$"\/('+"$*"/&"W?2"%+'"81&",$".*0'$4+"
('&*4<R0R/&'@1"H$,.&*($"'&,.+0'&;1&"4.)%/$",$"&L,+)$*"
4$"$8.,$*9.&'Z"/&"%+4.9.M*",$/"\/('+"&"/&".OQR.$',&",$"/&"
/1*$&")$,.&F"4.$*,+"4R"/+9&/.O&9.M*"9+''$9(&"&"*.8$/",$/"
9R$'%+"8$'($L'&/",$"N^@a":&)L.E*"'$%'$4$*(&"R*";&9(+'"
,$"'.$40+"%&'&"('+)L+4.4"8$*+4&"%'+;R*,&@"6R$,$"&4+­
9.&'4$"9+*"8$*&"'$*&/".OQR.$',&"'$('+&M'(.9&@23
Interrupción de la VCI con continuación en la ácigos o hemiácigos
3&<" R*&" ;&//&" $*" /&" ;+')&9.M*" ,$" /&" &*&4(+)+4.4"
4RL9&',.*&/>U$%Z(.9&"<"4RL4$9R$*($)$*($"$I.4($"&('+\&"
,$"/&"8$*&"4RL9&',.*&/"VW?2"4R%'&''$*&/",$'$9U&X@"N&"W?2"
.*;'&''$*&/"4$"9+*(.*Y&"9+*"/&"Z9.0+4""VU$).Z9.0+4"4."$4"W?2"
.OQR.$',&X"<"4$"&4+9.&"9+*"/&"8$*&"'$*&/".OQR.$',&"'$('+&M'­
tica en todos los casosBFcFe"V\0R'&"BeF".)Z0$*$4"D&>D,X@"=4"
)R<"'&'&F"%$'+"9+)Y*"$*"&*+)&/1&4",$/"situs"&L,+).*&/F"
%'.*9.%&/)$*($"$*"&QR$//&4"QR$"9R'4&*"9+*"%+/.$4%/$*.&"
V4+*")R<"'&'&4"/&4"QR$"9R'4&*"9+*"&4%/$*.&X"<"0$*$'&/­
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9+*;R*,.,&4"9+*"&,$*+%&(1&4"<"0$*$'&'",$49+*9.$'(+"&/"
+L4$'8&'"%'+).$*9.&",$"$4(+4"8&4+4"$*"$4(R,.+4",$"(M'&IF"
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/&"%/&*$&9.M*",$"9.'R01&"9&',1&9&"<"'$%'$4$*(&"R*"'.$40+"
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Ausencia de la VCI infrarrenal
=*"/+4"$4(R,.+4",$":?H#"*+"4$".,$*(.\9&"R*&"$4('R9­
(R'&"8&49R/&'"QR$"%R$,&",$\*.'4$"9+)+"W?2".*;'&''$*&/F"
Figura 13."W?2".*;$'.+'".OQR.$',&@
Y*.9&)$*($")Y/(.%/$4"8&4+4"8$*+4+4"4$'%$*(.0.*+4+4"
$*"'$('+%$'.(+*$+@"6R$,$"$4(&'"%'$4$*($"+"*+"$/"4$0­
)$*(+"4R%'&''$*&/",$"/&"W?2@2
Imagen 4."HRh$'",$"_b"&p+4@"=*"/&":?H#"4$"$8.,$*9.&"QR$"/&"W?2"$4(Z"&"/&".OQR.$',&",$"/&"&+'(&"V&X`"4$"R*$"&"/&"8$*&"'$*&/"
.OQR.$',&"<"9'RO&"/&"/1*$&")$,.&F"&*($'.+'"&"/&"&+'(&"VLX"<"4$"9+*(.*R&"9+*"/&"W?2".*('&U$%Z(.9&@"-$9+*4('R99.M*"9+'+*&/"H26F"
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1 1 0 Abril­Junio 2012
+'%()*
!"#$%&'%()*
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Z9.0+4"+"U$).Z9.0+4@
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4RL9R(Z*$+"V4R%$'\9.&/$4XcF^"QR$"R/($'.+')$*($",'$*&*"
$*"/&4"8$*&4"Z9.0+4"<"U$).Z9.0+4"V\0R'&"BDF".)Z0$*$4"
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<"%R$,$",$L$'4$"&"('+)L+4.4",$"/&"W?2"$*"$/"%$'.+,+"
.*('&R($'.*+"+"%$'.*&(&/F"<"*+"&41"&"R*",$;$9(+"$)L'.+0E­
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Discusión
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//&O0+4" .*9.,$*(&/$4" $*" $4(R,.+4" ,$" :?H#" QR$F" 4.*"
$)L&'0+F" %R$,$*" %&4&'" ,$4&%$'9.L.,&4@" 7$" U&" ,$­
)+4('&,+"QR$"/&4"&*+)&/1&4",$"/&"W?2"%R$,$*"($*$'"
R*&" '$%$'9R4.M*" U$)+,.*Z).9&" <" $*" 9+*4$9R$*9.&"
representar factores predisponientes para varias enti­
,&,$4"%&(+/M0.9&4F"9+)+"$/"8&'.9+9$/$"<"$/"41*,'+)$",$"
9&49&*R$O"9+*,.9.+*&,+"%+'"/&""8$*&"'$*&/".OQR.$',&"
'$('+&M'(.9&"+"9.'9R)&+'(.9&`"$4"%+'"$//+"QR$"9+*4.,$­
'&)+4"%$'(.*$*($"QR$F"$*"(+,+"%&9.$*($")&49R/.*+"$*"
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,$"8&'.9+9$/$@33
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profunda de miembros inferiores con indicación de \/('+",$"8$*&"9&8&".*;$'.+'F"/&",R%/.9&9.M*".*;'&''$*&/"
,$"/&"W?2"'$QR$'.'Z",+L/$"\/('+"%&'&"9+*('&''$4(&'"$/"
'.$40+",$"$)L+/.4)+`"W?2".OQR.$',&"$4"9+*('&.*,.9&­
9.M*"%&'&"9+/+9&9.M*",$"\/('+"('&*4<R0R/&'@"=*"$4(&4"
4.(R&9.+*$4" /&" :?H#" ,$)R$4('&" ,$" )&*$'&" 9/&'&"
(&*(+"/&",R%/.9&9.M*"9+)+"/&"%+4.9.M*".OQR.$',&",$"/&"
W?2@"J.*&/)$*($F"$*"%&9.$*($4"9+*"&R4$*9.&",$"W?2"
,$L$'1&*" 9+*4.,$'&'4$" )$,.,&4" ,$" %'$8$*9.M*" ,$"
Imagen 5.":?H#",$"&L,+)$*";$)$*.*+",$"De"&p+4@"7$"+L4$'8&"8$*&"'$*&/".OQR.$',&"'$('+&M'(.9&"V&F"]$9U&XF"/&"8$*&"Z9.0+4"$4"
%'+).*$*($"hR*(+"&"/&"&+'(&"$*"$/"$4%&9.+"'$('+9'R'&/"VLF"9"<",F"]$9U&4X""<"&R4$*9.&",$"W?2".*('&U$%Z(.9&"VLF"]$9U&",.49+*(.*R&X@"
N&4"8$*&4"4R%'&U$%Z(.9&4",'$*&*",.'$9(&)$*($"$*"/&"&R'19R/&",$'$9U&"V9F"]$9U&",.49+*(.*R&X@"N&"Z9.0+4"4.0R$"4R"('&<$9(+"
U&L.(R&/",$4$)L+9&*,+"$*"/&"8$*&"9&8&"4R%$'.+'"V,F"]$9U&X@
Abril­Junio 2012
111
Ácigos
Hemiácigos Imagen 6.":?H#"QR$",$)R$4('&"%'+).*$*9.&",$"/&4"8$*&4"
Z9.0+4"<"U$).Z9.0+4"9+*"%'$4$'8&9.M*",$"/&"W?2".*('&U$%Z(.9&"
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9R(Z*$+@"VL"<"9F"]$9U&4X@"-$9+*4('R99.M*"9+'+*&/"9R'8.%/&*&'"
4.0R.$*,+"$/"('&<$9(+",$"/&4"8$*&4"9+/&($'&/$4"%&'&$4%.*&/$4"
V,X`"4$"&,8.$'($"/&"%'+).*$*9.&",$"/&4"8$*&4".*('&%E/8.9&4"<"
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/R)L&'$4"V]$9U&4X@
Figura 15."KR4$*9.&",$"/&"W?2".*;'&''$*&/@
('+)L+4.4"8$*+4&"%'.*9.%&/)$*($"4."U&<"+('+4";&9(+'$4"
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+('&4" %+4.L./.,&,$4" QR$" .)%/.QR$*" $''+'@ 6+'" ('&(&'4$"
,$"R*"$4(R,.+",$"9&)%+",$"$I%/+'&9.M*"&)%/.+"%$').($"
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%R$,$"4$'"/&",./&(&9.M*"8&'.9+4&",$"8$*&4"&]R$*($4"+"
('+)L+4.4"8$*+4&@
Conclusiones
N&4"&*+)&/1&4"9+*0E*.(&4",$"/&"W?2"0$*$'&/)$*($"
4+*" U&//&O0+4" .*9.,$*(&/$4" $*" :?H#`" 4.*" $)L&'0+F"
(.$*$*".)%+'(&*($4".)%/.9&9.+*$4"9/1*.9&4"<"QR.'Y'0.9&4"
<" %R$,$*" ,&'" %.$" &" 9+*;R4.+*$4" $*" /+4" $4(R,.+4" ,$"
.)&0$*"%+'"/+"QR$"$4"*$9$4&'.+"9+*+9$'/&4@"=/"$4(R,.+"
,$"/&"$)L'.+0E*$4.4"&<R,&"&"9+*+9$'"4R4")$9&*.4)+4"
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Abril­Junio 2012
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