Quiz #25: Echo - Identify the vessel (again!)

Quiz #25:

Going with the same theme in Quiz #24.

Subcostal sagittal (bicaval) view in a newborn with severe cyanosis.

(Some labels are given because the picture is somewhat unclear. Clue: A vertical vessel flowing downwards, behind the IVC).

Question:

1)      Name the vessel shown by arrow.

2)      Provide a possible diagnosis. (I won’t be upset if you gave a second possible diagnosis as well!)

Answers:

1)      Vertical vein with flow from above downwards.

2)      Infradiaphragmatic type TAPVR

a.       Second possibility: SVC obstruction with decompression via Azygos vein (flowing downwards),

b.      Other possibilities (but, not typical) given by fellows who replied were

                                                               i.      Veno-venous collateral – I guess this may occur anywhere when there is a “set up” for it.

                                                             ii.      Scimitar syndrome – But, I think, the scimitar vein does not cross diaphragm as far as this image shows.