A Thoracoabdominal Aorta Aneurysm Patient with Severe Calcification in Arch of Riolan

Background: The co-existence of thoracoabdominal aortic aneurysm and arch of Riolan has not been reported yet. This article is to describe a rare phenomenon of severe calcification in arch of Riolan, as well as other anatomic variation in arteries and veins in the same patient. Methods and findings: A 53 year old man with abdominal wall varicosis was reported with a thoracoabdominal aorta aneurysm and severe stenosis of celiac trunk and superior mesenteric artery. There were multiple calcification and non-calcified plaques inside the wall of abdominal aorta and its branches, including arch of Riolan. A Budd-Chiari Syndrome was also reported. The intra-hepatic inferior vena cava was narrow and infra-hepatic inferior vena cava was enlarged with multiple intra-cavity calcifications. His right renal vein was drained into supra-hepatic inferior vena cava. Two cover stents were implanted near ostia of renal vessels. The aneurysm was cured and patient recovered uneventfully. Conclusion: A combination of thoracoabdominal aorta aneurysm and arch of Riolan is rarely reported. Hemodynamic factor may explain why severe calcified plaques only exist in arch of Riolan but not in other branches of aorta. Calcification of inferior vena cava is extremely rare in adults, and a possibly relevant situation is structural anomalies.


Hui Zhang, Guangxin Cao, Jiang Shao, Yu Chen, Yue Hong Zheng

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