What is the most likely diagnosis?

• 35 year-old whose pre-employment chest radiograph shows abnormal shadow

Frontal and Lateral Chest Radiograph

1. Pneumomediastinum
2. Sarcoid
3. Neurofibroma
4. Interrupted IVC with Azygos Continuation
5. Mitral Stenosis

Additional Image - Enhanced axial CT images of chest and abdomen

 

Additional Images

 

Enhanced axial CT images of chest and abdomen

Answer:

4.Interrupted IVC with Azygos Continuation

 

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Interrupted IVC with Azygos Continuation

General Considerations

• Rare
• Frequently associated with other congenital anomalies
• Occurs in 0.6% of patients with congenital heart defects
• In usual form, the IVC is interrupted above level of renal veins
• There is absence of the hepatic segment of the IVC and the post-renal IVC continues as azygos and hemiazygos veins
• Embryologically, there is a failure to form right subcardinal–hepatic anastomosis resulting in atrophy of right subcardinal vein

 

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