IS Case 311: Circumaortic left renal vein

Gunvir Gill, MD

Imaging Sciences URMC 2009
Publication Date: 2009-09-14

History

Patient is a 78-year-old female with breast cancer on chemotherapy.

Findings

Duplication of the left renal vein, with one component passing anterior and another component passing posterior to the aorta.

Discussion

The most common anomaly of the left renal venous system is the circumaortic renal vein, seen in up to 9% of patients. In this anomaly, the left renal vein bifurcates into a ventral and dorsal limb, which encircle the abdominal aorta. The ventral component usually drains the anteroinferior kidney, while the dorsal component usually drains the posterosuperior kidney.

A relatively benign incidental anatomical variant, a circumaortic renal vein can nonetheless have clinical consequences and bears comment in reports. For instance, it commonly occurs that the renal veins drain into the IVC at different levels. If such a patient is to undergo IVC filter placement, care should be taken to place the filter inferior to the confluence of the lowest renal vein. Interventional varicocele embolization is another relatively common procedure that is rendered technically difficult by variability in the site of confluence of the left renal vein and the left spermatic vein, leading some practitioners to resort to jugular or femoral vein approaches for embolization. Adrenal or renal venous sampling and renal surgery are two other clinical scenarios where a thorough knowledge of the renal venous system is essential.

References

  1. Parikh SJ, Peters JC, Kihm RH. The anomalous left renal vein: CT appearance and clinical implications. J Comput Tomogr. 1981 Dec;5(6):529-33. PMID: 7343174
  2. Tay KH, Martin ML, Mayer AL, Machan LS. Selective spermatic venography and varicocele embolization in men with circumaortic left renal veins. J Vasc Interv Radiol. 2002 Jul;13(7):739-42. PMID: 12119335
  3. Webb WR, Brant WE. Major NM. Fundamentals of Body CT. 3rd ed., W.B. Saunders, 2005.

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