Absence of infra-renal segment of inferior vena cava with anomalous right renal vein

Various anomalies of the inferior venacava (IVC) have been reported in the past. Amongst, the absence of IVC is one of the less frequently reported anomalies. The absence can be complete or partial, confined to the hepatic, supra-renal or infra-renal segment of IVC. It is still a controversy, whether these conditions are true embryonic anomalies or the result of perinatal IVC thrombosis. A man in his mid 30's presented with absence of the infra-renal IVC and both common iliac veins. The right renal vein is replaced by a long tortuous vessel, similar to the appearance of collateral vessel. He presented with extensive varicose veins on the anterior abdominal wall, severe varices of right leg with ulcer. A coronal multiplanar reconstruction CT imaging was used to document the anomaly. Prior knowledge of this anomaly is vital, especially if these individuals are subjected to undergo cardiac procedures via femoral vein access.