There are more anatomical variants in heaven and earth, Horatio, than are dreamt of in our philosophy: the precaval left renal artery

  • Enrico Capaccio
  • Michele Bertolotto
  • Andrea Paladini
  • Giulio Cecchini
  • Simona Manole
  • Sorin Dudea
  • Mustafa Secil
  • Lorenzo E. DerchiEmail author



To describe the CT findings in eight patients with left-sided inferior vena cava (IVC) in whom the left renal artery presented a precaval course (pLRA).

Materials and methods

We searched the teaching files of six radiology departments for patients with pLRAs. Eight patients were found, and the available imaging studies and clinical histories were reviewed. Associated vascular and renal anomalies were noted.


No patient had been examined for problems related to the vascular anomaly found. Four had a double IVC and two a solitary left IVC; in all, the left-sided IVCs had hemiazygos continuation. One patient had situs viscerum inversus. In one case, there was a left kidney in left iliac fossa.


Although rare and probably overlooked, a pLRAs can be encountered in patients with situs viscerum inversus or presenting a left-sided IVC with hemiazygos continuation. These vessels can cause technical problems during surgery at the left renal hilum and should be specifically searched for in patients with vascular anomalies.


Renal vessels Anomalies IVC Hemiazygos continuation of IVC Left-sided precaval renal artery 



This study has received no funding.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standards

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

This study was approved, and the need for informed consent was waived by the ethics committee of the institution of the corresponding author (335REG2014).


  1. 1.
    Satyapal KS, Haffejee AA, Singh B, Ramsaroop L, Robbs JV, Kalideen JM (2001) Additional renal arteries: incidence and morphometry. Surg Radiol Anat 23:33–38CrossRefGoogle Scholar
  2. 2.
    Yeh BM, Coakley FV, Meng MV, Breiman RS, Stoller ML (2004) Precaval right renal arteries: prevalence and morphologic associations at spiral CT. Radiology 230:429–433CrossRefGoogle Scholar
  3. 3.
    Bouali O, Labarre D, Molinier F, Lopez R, Benuaich V, Lauwers F, Moscovici J (2012) Anatomic variations of the renal vessels: focus of the precaval right renal artery. Surg Radiol Anat 34:441–446CrossRefGoogle Scholar
  4. 4.
    Buisman WJ, Unlu C, de Boer SW, Bos WJ, Nieuwenhuijs JK, Wille J (2016) An undetected common renal arterial trunk: surgical consequences and morbidity analysis. Surg Radiol Anat 38:111–1114CrossRefGoogle Scholar
  5. 5.
    Minniti S, Visentini S, Procacci C (2002) Congenital anomalies of the venae cavae: embryological origin, imaging features and report of three new variants. Eur Radiol 12:2040–2055CrossRefGoogle Scholar
  6. 6.
    Allen HA, Haney PJ (1981) Case report. Left sided inferior vena cava with hemiazygos continuation. JCAT 5:917–920Google Scholar
  7. 7.
    Cohen MI, Gore RM, Vogelzang RL, Rochester D, Neiman HL, Crampton AR (1984) Accessory hemiazygos continuation of the left inferior vena cava: CT demonstration. JCAT 8:777–779Google Scholar
  8. 8.
    Munechika H, Cohan RH, Baker ME, Cooper CJ, Dunnick NR (1988) Hemiazygos continuation of a left inferior vena cava: CT appearance. JCAT 12:328–330Google Scholar
  9. 9.
    Brickner ME, Eichhorn EJ, Netto D, Cigarroa RG, Brogan WC III, Simonsen RL, Grayburn PA (1990) Left-sided inferior vena cava draining into the coronary sinus via persistent left superior vena cava: case report and review of the literature. Cathet Cardiovasc Diagn 20:189–192CrossRefGoogle Scholar
  10. 10.
    Sener RN, Alper H (1994) Polysplenia syndrome: a case associated with the hepatic portal vein, short pancreas and left inferior vena cava with hemiazygos continuation. Abdom Imaging 19:64–66CrossRefGoogle Scholar
  11. 11.
    Sheth S, Fishman EK (2007) Imaging of the inferior vena cava with MDCT. AJR 189:1243–1251CrossRefGoogle Scholar
  12. 12.
    Ekwenna O, Gorin MA, Castellan M, Casillas V, Ciancio G (2011) Inverted nutcracker syndrome: a case of persistent hematuria and pain in the presence of a left-sided inferior vena cava. Sci World J 11:1031–1035CrossRefGoogle Scholar

Copyright information

© Italian Society of Medical Radiology 2019

Authors and Affiliations

  1. 1.Department of Radiology, Radiologia d’UrgenzaAOU IRCCS San Martino ISTGenoaItaly
  2. 2.Department of RadiologyUniversity of TriesteTriesteItaly
  3. 3.Department of RadiologyUniversità Cattolica del Sacro Cuore, Policlinico A. GemelliRomeItaly
  4. 4.Diagnostica per Immagini Ospedaliera, Ospedale Evangelico Internazionale, presidio ospedaliero di VoltriGenoaItaly
  5. 5.Department of RadiologyUniv Med Pharm “Iuliu Hatieganu”Cluj-NapocaRomania
  6. 6.Department of Radiology, Faculty of MedicineDokuz Eylul UniversityIzmirTurkey
  7. 7.Department of Health Sciences (DISSAL), Radiology SectionUniversity of Genoa, Radiologia d’Urgenza, Ospedale Policlinico San Martino ISTGenoaItaly

Personalised recommendations