case_images: PMC11347273_01
case_images: Images of the mass in inferior vena cava (IVC) and right atrium on enhanced CT. (A) Coronal image showed multiple soft tissue masses surrounding the uterus, extending from the left ovarian vein, left renal vein, and IVC to the right atrium (asterisks). (B) Transverse section showed that the lesion occupies almost the entire right atrium.
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case_images: PMC11347273_01_fmed-11-1422652-g001.jpg
case_images: F1
case_images: Abdominal enhanced computed tomography (CT) and inferior vena cava CT venography (CTV) demonstrated the presence of multiple soft tissue masses surrounding the uterus, extending from the left ovarian vein, left renal vein, and inferior vena cava to the right atrium (Figure 1).
case_images: The transverse sections of enhanced abdominal CT images. (A) The second hepatic hilum was obstructed by the mass. (B,C) Arrows demonstrated the presence of communicating branches between the hepatic veins. (C) The arrow head pointed the dilated accessory hepatic vein.
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case_images: PMC11347273_01_fmed-11-1422652-g002.jpg
case_images: F2
case_images: Additionally, the formation of communicating branches between the hepatic veins was observed (Figure 2).
case_images: Images of transthoracic echocardiogram. (A,B) The asterisks indicated the hypoechoic mass located within the right atrium and inferior vena cava, measuring 6.3 cm x 4.8 cm in dimensions. (B) The inferior vena cava exhibited dilation with a proximal diameter of 3.1 cm.
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case_images: PMC11347273_01_fmed-11-1422652-g003.jpg
case_images: F3
case_images: The mass can also be visualized within the right atrium and inferior vena cava using gray scale ultrasound imaging, appearing as a hypoechoic lesion of considerable length (Figure 3).
case_images: Images of liver greyscale and color Doppler sonography. (A) The lesion (asterisk) obstructed the blood flow from the left and middle hepatic veins to the inferior vena cava, resulting in a reversal of blood flow from the left hepatic vein into the middle hepatic vein. (B) Arrows show the direction of the blood flow: the white arrows illustrate the normal direction of blood flow, while the yellow arrows indicate the retrograde flow of the proximal segment of MHV, which drains LHV and redirects it through collateral vessels (red arrows) to the veins in the right lobe of the liver. LHV, left hepatic vein; MHV, middle hepatic vein.
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case_images: PMC11347273_01_fmed-11-1422652-g004.jpg
case_images: F4
case_images: We can see that there is obstruction in the blood flow of the left and middle hepatic veins, resulting in a reversal of blood flow from the left hepatic vein into the middle hepatic vein (Figure 4).
case_images: Images of collateral circulation between hepatic veins on greyscale and color Doppler sonography. White arrows indicated the collateral veins. (A,C) Gray-scale images displayed the collateral veins connecting MHV and the dilated accessory hepatic vein in the posterior right lobe from various perspectives. (B,D) Color Doppler blood flow images illustrated the blood flow within the collateral veins from different angles. The blood flow direction was observed to move from MHV toward the dilated accessory hepatic vein, ultimately draining into the inferior vena cava. The asterisk denoted the presence of a tumor. LHV, left hepatic vein; MHV, middle hepatic vein; AHV, accessory hepatic vein.
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case_images: PMC11347273_01_fmed-11-1422652-g005.jpg
case_images: F5
case_images: This obstruction has led to the formation of multiple collateral circulations between the middle hepatic vein and either the right hepatic vein or the dilated accessory hepatic vein in the posterior right lobe (Figure 5).