Azygous Continuation of the Inferior Vena Cava: Potential Misdiagnosis as Liver Cirrhosis

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Azygos continuation of the inferior vena cava (ACIVC) (n=1). Intervention: CT angiography and multidisciplinary imaging review. Primary outcome: Definitive diagnosis of azygos continuation of the inferior vena cava.

Ethan Shamsian; Joshua E. Pagán-Busigó; Raphael Shankman; Sameer Rao; Rohan Karkra; Mohammad-Ali Mousavi; Nina Brogle; Sima Vossough‐Teehan

doi:10.14309/crj.0000000000001998

February 1, 2026ACG Case Reports JournalOpen Access

Azygous Continuation of the Inferior Vena Cava: Potential Misdiagnosis as Liver Cirrhosis

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Key result

CT angiography confirms azygos continuation of the IVC, resolving misdiagnosed cirrhosis and portal hypertension.

n=1

Key Points

To report a case of azygos continuation of the inferior vena cava (ACIVC) mimicking portal hypertension and liver cirrhosis on initial imaging, highlighting key diagnostic pitfalls.
Clinical evaluation, laboratory testing, and cross-sectional imaging review for a 37-year-old man presenting to the emergency department with groin pain and suspected cirrhosis-related varices.
Work-up for acute and chronic liver disease etiologies, followed by multidisciplinary review and contrast-enhanced CT angiography.
Initial abdominal CT demonstrated enlargement of the left and caudate hepatic lobes alongside prominent mediastinal and paraspinal variceal structures, prompting a presumptive cirrhosis diagnosis despite normal liver labs (platelets 152 × 10 9 /L, AST 15 U/L, ALT 18 U/L, INR 1.1, albumin 3.8 g/dL, FIB-4 1.05).
Follow-up CT angiography demonstrated congenital atresia of the IVC at the portohepatic level with reconstitution and large collateral venous networks draining through a massive azygos vein, confirming ACIVC and avoiding invasive liver biopsy.

Study Design

Type

Case Report (n=1)

Multicenter

No

PICO

P

Population

1 male patient (aged 37 years) with azygos continuation of the inferior vena cava initially misdiagnosed as cirrhosis and portal hypertension, followed for 9 months.

E

Exposure / Comparator

CT angiography and multidisciplinary imaging review

O

Primary Outcome

Definitive diagnosis of azygos continuation of the inferior vena cava

Limitations

Inherent constraints of a single case report limiting generalizability
Diagnosis relied heavily on cross-sectional imaging, which may not always be readily available or correctly interpreted in all clinical settings
Long-term natural history and potential clinical implications of ACIVC in this patient remain to be determined

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Implication

Case report reveals misdiagnosis of azygos continuation in a male patient, highlighting diagnostic complexities.

Abstract

Azygos continuation of the inferior vena cava (ACIVC) is a rare congenital anomaly characterized by the absence of the intrahepatic segment of the inferior vena cava. Although typically benign and incidental, it can mimic other pathologies on imaging. We present a case of ACIVC in a 37-year-old man, initially misdiagnosed as portal hypertension with mediastinal varices and possible liver cirrhosis, with the diagnosis ultimately confirmed by CT angiography demonstrating ACIVC. This report highlights the diagnostic challenges of ACIVC and underscores the importance of correlating imaging findings with the clinical picture for accurate diagnosis.

Discussion

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Cite This Study

Shamsian et al. (2026) conducted a case report in Azygos continuation of the inferior vena cava (ACIVC) (n=1). CT angiography and multidisciplinary imaging review was evaluated on Definitive diagnosis of azygos continuation of the inferior vena cava. CT angiography confirmed azygos continuation of the inferior vena cava in a 37-year-old man, resolving an initial misdiagnosis of cirrhosis and portal hypertension.

synapsesocial.com/papers/698827e20fc35cd7a8846dff https://doi.org/10.14309/crj.0000000000001998

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Azygous Continuation of the Inferior Vena Cava: Potential Misdiagnosis as Liver Cirrhosis

Key Points

Study Design

PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Azygous Continuation of the Inferior Vena Cava: Potential Misdiagnosis as Liver Cirrhosis

Key Points

Study Design

PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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