Abstract
We report the case of a 70-year-old woman presenting with chronic vertigo and vomiting due to Meniere-like symptoms. Abdominal ultrasonography was performed, revealing an anechoic mass connected to the retrohepatic/suprarenal inferior vena cava (IVC); color Doppler imaging showed venous flow from the IVC into the mass-like space. Enhanced computed tomography (CT) demonstrated a saccular aneurysm without IVC interruption. The maximal diameter was 25 mm and the length was 45 mm. CT showed neither mural thrombus in the IVC aneurysm nor thrombus of the pulmonary artery. IVC angiography showed several compartments divided by partition walls and delayed washout of contrast agent in the aneurysm. Endoluminal observation was performed, perspectively and consecutively, with virtual vascular endoscopy (VVE) using three-dimensional ultrasonography, from inside the IVC into the intra-aneurysmal space. VVE imaging indicated the direct opening of the aneurysm orifice from the IVC and delineated the intra-aneurysmal structure, including the compartments of the inner wall of the aneurysm. In lieu of anti-coagulation therapy or surgical removal, she was started on oral anti-platelet therapy because of a lack of history of thrombosis.
