Impact of intraoperative intravenous heparin bolus on clinical outcomes during radical nephrectomy and IVC tumor thrombectomy in renal cell carcinoma with level I-IV IVC thrombus: A multi-institutional study.

Primary leiomyosarcoma of the inferior vena cava (IVC) is a rare malignant smooth muscle tumor, representing fewer than 1 in 100,000 adult cancers and less than 0.5% of soft tissue sarcomas. Despite its rarity, it is the most common primary tumor of the IVC and typically aff ects women in their 50s to 60s. Clinical presentation is often silent or nonspecific, resulting in late diagnosis and poor long-term outcomes. Surgical resection remains the only potentially curative treatment, and IVC reconstruction may be necessary depending on tumor location and extent. We present a video demonstrating robotic resection and reconstruction of the IVC in a 75-year-old patient with a 5.5 cm leiomyosarcoma located below the left renal vein, exhibiting both intraluminal and extraluminal growth. Patient underwent robotic en bloc resection of the tumor and a 6 cm segment of the IVC. Reconstruction was performed using a tubularized bovine pericardium graft. Total operative time was 440 minutes, with 80 minutes of IVC clamping and 180 mL of blood loss. No transfusion was required, postoperative recovery was uneventful, and the patient was discharged on postoperative day six. Imaging confi rmed graft patency, and final pathology reported high-grade leiomyosarcoma (T3N0M0). To our knowledge, this is the first reported case of robotic resection of IVC leiomyosarcoma and only the second reported robotic IVC resection and reconstruction in the English literature. This case supports the feasibility and safety of a minimally invasive robotic approach for complex vascular oncologic surgery.

Residual congestion at discharge in acute heart failure (AHF) is a primary driver of readmission and mortality. Inferior vena cava (IVC) ultrasound provides a noninvasive bedside assessment of volume status, yet its clinical impact on guiding therapy remains underdefined. This systematic review evaluated the efficacy of IVC ultrasound-guided therapy compared to standard clinical assessment in AHF decongestion. Following PRISMA guidelines (PROSPERO: CRD420251171323), a systematic search was conducted across PubMed, EMBASE, and other major databases through October 2025. We included randomized controlled trials (RCTs) and nonrandomized studies focusing on IVC-guided management in adults with AHF. Outcomes included congestion markers, NT-proBNP levels, hospitalization duration, and mortality. Four studies involving 629 patients met the inclusion criteria. Most studies showed improved decongestion with IVC ultrasound guidance, evidenced by lower residual congestion and improved IVC metrics (diameter/collapsibility). While NT-proBNP levels decreased in all cohorts, between-group differences were not statistically significant. Clinical outcomes improved in 50% of studies, showing shorter hospital stays and reduced mortality. Notably, one trial reported a significant mortality benefit (3.3%vs. 33.3%; p = 0.003). Adverse events were either similar or significantly fewer (p<0.05) in the ultrasound-guided groups. IVC ultrasound is an effective bedside tool for individualized volume management in AHF, potentially enhancing treatment precision and clinical outcomes. While current evidence is promising, larger multicenter trials are necessary to standardize its implementation in routine heart failure care.

Purpose To develop and evaluate a preoperative MRI-based model for predicting inferior vena cava (IVC) wall invasion in renal cell carcinoma (RCC) with IVC tumor thrombus (IVCTT) and to compare its performance with that of individual MRI features and radiologists' subjective assessments. Materials and Methods This single-center study with retrospective and prospective components included individuals who underwent or were scheduled to undergo surgery for RCC with IVCTT (retrospective training set, n = 173, January 2005-December 2023; prospective temporal validation set, n = 44, January 2024-September 2025). Histopathology served as the reference standard. Quantitative (tumor, vessel, and thrombus measurements) and qualitative (signal and morphologic characteristics) MRI features were assessed. Two fellowship-trained abdominal radiologists independently provided subjective assessments of IVC wall invasion, and interobserver agreement was assessed. Variables significant at univariable analysis were entered into multivariable logistic regression to identify predictors of IVC wall invasion. Diagnostic performance was compared using receiver operating characteristic (ROC) curve analysis and DeLong tests. Results A total of 217 individuals were included (mean age, 57 years ± 12 [SD], 166 male). Four independent predictors of IVC wall invasion were identified: bland thrombus (odds ratio [OR] = 3.32 [95% CI: 1.38, 8.03]), lumbar vein diameter (>5.25 mm) (OR = 2.64 [95% CI: 1.23, 5.69]), ipsilateral renal vein ostium diameter (>19.20 mm) (OR = 3.64 [95% CI: 1.73, 7.63]), and thrombus craniocaudal length (>46.95 mm) (OR = 3.08 [95% CI: 1.43, 6.63]). The multivariable model incorporating these predictors achieved area under the ROC curve (AUC) values of 0.81 (95% CI: 0.75, 0.88) and 0.84 (95% CI: 0.73, 0.96) in the training and validation sets, respectively, significantly outperforming the best individual MRI predictor (AUC = 0.71) and radiologists' subjective assessments (AUC = 0.66) (all P < .05). Conclusion The multiparametric MRI-based model demonstrated good discriminatory performance for predicting IVC wall invasion and outperformed individual MRI features and subjective radiologist assessment. Keywords: MR Imaging, Urinary, Kidney, Renal Cell Carcinoma, Magnetic Resonance Imaging, Inferior Vena Cava Tumor Thrombus, Venous Wall Invasion Supplemental material is available for this article. © RSNA, 2026.

Mechanical approach of some liver diseases and their impact on hemodynamics.

To develop and validate a model by incorporating abdominal multi-organ non-contrast computed tomography (CT) radiomics and clinical features to predict the feasibility of hepatic encephalopathy (HE) occurrence in patients with cirrhosis and hepatorenal failure. In total, 351 consecutive patients with cirrhosis and hepatorenal failure undergoing non-contrast abdominal CT scans at Centers 1 and 2 were enrolled. Patients from Center 1 were randomly allocated to training (n = 191) and internal test (n = 81) groups, and those from Center 2 were assigned to the external test group (n = 79). The nnU-Net framework was used for automated three-dimensional (3D) segmentation of abdominal organs-the liver, spleen, portal and splenic vein, inferior vena cava, esophagogastric junction, stomach, liver-adjacent small bowel, and colon. Segmented multi-organ radiomics features were extracted using 3D Slicer, with R software used for feature processing and model construction. Model performance in predicting HE occurrence was evaluated using receiver operating characteristic (ROC) analysis in the training, internal test, and external test cohorts. Decision curve analysis (DCA) was used to evaluate clinical utility. The SHapley Additive exPlanations (SHAP) tool was used to provide a basis for model interpretability analysis. In total, 351 patients (mean age, 61.3 ± 10.7 years; 231 men) were enrolled in this study. Esophageal variceal bleeding, peritonitis, and ascites were independent clinical predictors of HE. Twenty discriminative radiomics features, selected from the abovementioned multi-organs through intraclass correlation coefficient and least absolute shrinkage and selection operator analysis, were used to construct the radiomics model. The integrated model, incorporating both radiomics and clinical features, obtained higher areas under the ROC curve than the radiomics and clinical models in the training (0.87 vs. 0.83 vs. 0.68), internal test (0.85 vs. 0.81 vs. 0.66), and external test (0.83 vs. 0.78 vs. 0.72) cohorts, as evidenced by favorable integrated discrimination improvement values (P < 0.05 for all). The integrated model demonstrated superior clinical utility in DCA. Moreover, SHAP feature contribution analysis revealed that the top five features in terms of contribution were all extracted from the digestive tract. The integrated model can effectively predict HE occurrence in patients with cirrhosis and hepatorenal failure. This novel model, developed by integrating abdominal multi-organ non-contrast CT radiomics and clinical features, demonstrates robust performance in predicting the occurrence of cirrhosis-related HE in patients with cirrhosis and hepatorenal failure. It thus provides a valuable tool for clinical decision-making, facilitating the prevention of this complication.

No Clear Association Between Intravenous Fluid Administration and Short-Term Worsening of Left Ventricular Function in Septic Patients with, or without, Heart Failure: A Bayesian Analysis.

Fluid overload in children undergoing dialysis can lead to serious cardiac complications, i.e., left ventricular hypertrophy (LVH) and cardiac dysfunction. Studies investigating the cardiovascular effects of persistent subclinical hypervolemia-characterized by euvolemia at clinical assessment but hypervolemia at technical evaluation-are lacking. This pilot study explored the combined use of lung ultrasound (LUS), bioimpedance spectroscopy (BIS), and ultrasound assessment of the inferior vena cava collapsibility index (IVC-CI) to identify subclinical hypervolemia and investigated its cardiac impact. In this longitudinal study, we recruited 23 children on chronic dialysis who underwent fluid status evaluation (physical examination, LUS, IVC-CI, BIS) every 2months and echocardiography every 6months. In clinically euvolemic patients, we observed a significant positive correlation between the interdialytic weight gain and the number of B-lines observed by LUS (R = 0.2923, p < 0.001); similar results were obtained for the OH/ECW measured by BIS (R = 0.4144, p < 0.001), while a negative correlation with IVC-CI (R = - 0.2597, p = 0.019) was observed. Moreover, we identified a significant linear correlation between left ventricular mass index values and the average pre-dialysis systolic blood pressure measured over the preceding 6months (R2 = 0.16, p = 0.002). Hospitalizations due to hypertensive crises (67% vs. 0%, p < 0.01) and the occurrence of LVH at the final follow-up (75% vs. 27%, p = 0.04) were notably more frequent in children with subclinical hypervolemia. In clinically euvolemic children on dialysis, the combined use of LUS, BIS, and IVC-CI (multiparametric approach) effectively quantified subclinical hypervolemia, which was correlated with the risk of LVH.

Mutations in antithrombin (SERPINC1) lead to the hereditary antithrombin deficiency. Conventional therapies for hereditary antithrombin deficiency are prophylactic or on-demand oral anticoagulants, which have poor compliance and side effects. This study explored the therapeutic efficacy of adeno-associated virus serotype 8 (AAV8)-mediated human SERPINC1 gene (AAV8-hSERPINC1) in AT (antithrombin)-deficiency mice. AAV8-hSERPINC1 carrying luciferase was injected into AT+/- mice via tail vein injection at low, medium, and high doses. The biodistribution and expression of the carrier were visualized by in vivo bioimaging technology. Plasma AT levels were serially monitored by ELISA, and an inferior vena cava model was established to evaluate thrombotic propensity. Safety was evaluated by monitoring hepatic, renal, and cardiac function parameters and employing flow cytometry. A dose-dependent increase in AT expression was observed in AT+/- mice after AAV8-hSERPINC1 injection. Compared with the untreated mice, medium-dose treatment restored plasma AT activity and antigen in AT+/- mice to normal levels by week 8, with maintenance within the normal reference range for 40 weeks. In the venous thrombosis model, the rate of thrombosis in mice treated with medium-dose AAV8-hSERPINC1, rivaroxaban, low-molecular-weight-heparin, and wild-type mice were 60%, 60%, 70% and 60%, respectively. After AAV injection, transient elevations in hepatic transaminases and cytokines were observed in mice during a short-term period. Our study demonstrates that AAV8-hSERPINC1 gene delivery resulted in durable AT expression, sustained blood hypercoagulation state correction, thereby rescuing thrombophilia in AT-deficient male mice. These data support the long-term efficacy and safety of AAV gene therapy for hereditary antithrombin deficiency.

To characterize tuberculous meningitis (TBM)-associated hyponatraemia and better understand its causality, progression, and influence on treatment outcomes. 208 Vietnamese adults with TBM, consecutively enrolled into two trials of adjunctive dexamethasone (ACT-HIV:NCT03092817; LAST-ACT:NCT03100786), had at least one measurement of plasma sodium, urinary sodium, serum osmolality, or urine osmolality during treatment. Fluid status was assessed by fluid balance and inferior vena cava ultrasound. TBM severity and clinical endpoints by 12 months were recorded. 176/190 (92.6%) participants with plasma sodium measured at presentation had hyponatraemia, with lower sodium associated with more severe TBM, and increased CSF inflammation. Pre-defined causality criteria applied to 34 participants with complete data suggested 7/34 (20.6%) had cerebral salt wasting (CSW) and 27/34 (79.4%) had the syndrome of inappropriate anti-diuretic hormone (SIADH). Dexamethasone therapy (vs. placebo) was associated with higher plasma sodium during the first 30 days, irrespective of baseline plasma sodium, however these associations did not reach statistical significance. During treatment, lower plasma sodium and higher 24-hour urinary outputs strongly predicted death and neurological events at 3 and 12 months. Hyponatraemia was strongly associated with more severe TBM and intracerebral inflammation. Persistent hyponatraemia and increasing urinary output during treatment associate with worse clinical outcomes.

In cases of inferior vena cava (IVC) obstruction, venous collaterals involving the hemiazygos and azygos veins can provide venous return to the right atrium. This can lead to procedural challenges in right heart catheterization (RHC). A 54-year-old male with end stage renal disease and severe aortic regurgitation underwent RHC for valve replacement planning. Swan Ganz catheter, via left femoral vein, would not advance beyond the distal IVC despite an inflated balloon. It was advanced over a V18 wire, taking a tortuous path to the right ventricle. Imaging revealed infrarenal IVC stenosis due to a dialysis catheter, with venous return through a dilated lumbar vein and hemiazygos and azygos collaterals. When catheter advancement fails, IVC stenosis and collateral pathways should be considered. Wire-guided navigation allows completion of RHC in these settings. Familiarity with venous anatomy enables successful RHC despite IVC obstruction. Early recognition and guidewire use can prevent procedural delays.

Renal cell carcinoma (RCC) is frequently associated with venous tumor thrombus (RCC-TT), which occurs in 5-20% of patients and significantly impacts surgical management. While CT and MRI provide excellent anatomic characterization, they offer limited insight into venous hemodynamics and venous collateralization, which are critical for operative planning in RCC-TT cases. Four-dimensional (4D) flow MRI is a time-resolved technique that enables simultaneous assessment of vascular anatomy and blood flow dynamics. In this pictorial essay, we illustrate the application of 4D flow MRI in RCC-TT across a spectrum of tumor thrombus levels. Through representative cases, we demonstrate how 4D flow imaging provides value over conventional imaging by clarifying vessel patency, flow directionality, and the presence and extent of collateral pathways. These insights are particularly relevant in determining whether the inferior vena cava (IVC) is functionally occluded, assessing redistribution of venous return, and anticipating tolerance to surgical maneuvers such as IVC cross-clamping, ligation, or resection. Our experience highlights that 4D flow MRI can reveal complex and variable patterns of venous drainage that are not readily apparent on standard imaging. By integrating hemodynamic information with anatomic findings, 4D flow imaging may enhance preoperative assessment and support surgical decision-making in patients with RCC-TT.

Inferior vena cava thrombosis (IVCT) is an uncommon manifestation of venous thromboembolism characterized by heterogeneous clinical presentations and a paucity of disease-specific evidence. Consequently, diagnostic and therapeutic approaches are largely extrapolated from studies of proximal lower-extremity deep vein thrombosis (LE-DVT), resulting in considerable variability in clinical practice.This consensus-based guidance was developed by the Italian Society for the Study of Haemostasis and Thrombosis (SISET) through a narrative review of the available literature and expert consensus. Key clinical questions addressed included patient selection for IVCT investigation, optimal diagnostic imaging strategies, indications for thrombophilia testing, and pharmacological and interventional treatment approaches.The guidance identifies clinical scenarios warranting dedicated evaluation of the inferior vena cava, including bilateral LE-DVT, atypical abdominal or lumbar pain, and extensive venous obstruction. Diagnostic imaging should be tailored to the clinical presentation and the suspected extent of thrombosis. Anticoagulation is recommended as the cornerstone of treatment for most patients with IVCT. Endovascular or surgical interventions may be considered in selected cases, particularly in patients with acute extensive thrombosis or chronic symptomatic ilio-caval obstruction. Recommendations regarding thrombophilia testing and long-term management are provided to support individualized patient care.Owing to the limited availability of high-quality IVCT-specific evidence, management decisions should be individualized and guided by clinical presentation, thrombotic burden, and patient characteristics. These consensus recommendations provide a practical framework for the diagnosis and management of IVCT while highlighting the urgent need for prospective studies to strengthen the evidence base in this rare but clinically relevant condition.

Mapping thrombus habitat: Non-contrast MRI radiomics and pixel-tile histomics approach to track venous thrombosis evolution in mice.

A 53-year-old woman with left lower back pain, anemia, proteinuria, and hematuria was found to have bilateral adrenal masses on ultrasonography. The subsequent contrast-enhanced MRI and 18F-FDG PET/CT revealed bilateral adrenal masses with locally extensive intravenous tumor thrombi. Postoperative pathology confirmed a malignant perivascular epithelioid cell tumor (PEComa) in the left adrenal region, with tumor thrombi involving the left renal vein, left ovarian vein, inferior vena cava, and right adrenal vein.

Infra-hepatic inferior vena cava (IVC) balloon occlusion is an effective strategy for reducing intraoperative bleeding during precision liver surgery, yet rapid balloon inflation can produce abrupt transient deviations in downstream venous pressure that are not yet quantitatively characterized. Current practice relies on operator experience, with no quantitative framework to balance occlusion efficacy against downstream pressure safety. A computational fluid dynamics (CFD) model of the balloon-occluded IVC was developed in ANSYS 2025 R2 with two-way fluid–structure interaction (FSI), Carreau–Yasuda blood rheology, and a balloon described by an Ogden hyperelastic model; the flow regime was laminar (Re ≈ 254). Reduced-order ARX models of four input–output subsystems were identified from CFD-generated data, and a model predictive control (MPC) strategy was formulated to penalize downstream pressure overshoot through a weighted cost function. The identified models achieved training normalized root-mean-square errors of 0.0363 to 0.1164 and out-of-sample validation errors of 0.1224 to 0.2381. Conventional sigmoid inflation induced a 45.82% overshoot in downstream pressure (Paft); the optimal input signal (q = [0,1,0,0], λ = 0.1) reduced this to 6.05%, a reduction of 39.77 percentage points, while preserving &gt;90% flow occlusion at UF = 3 × 104 Pa. The proposed framework offers a quantitative basis for balloon-occlusion device design that limits downstream pressure overshoot, motivating subsequent benchtop, ex vivo, and in vivo validation.

Objective: To investigate the feasibility and efficacy of ex vivo liver resection and autologous liver transplantation (ERAT) in the treatment of initially unresectable colorectal cancer liver metastases (CRLM). Methods: Four databases, including PubMed, Embase, Scopus and Web of Science, were systematically searched for literature on ERAT for CRLM published from database inception to May 13, 2025. Meanwhile, clinical data of CRLM patients who underwent ERAT at the Department of Hepatopancreatobiliary Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine between 2021 and 2024 were collected. Perioperative conditions and prognosis of the patients were summarized. Results: (1) Literature review: A total of 13 patients with CRLM who underwent ERAT from 5 studies were included. Among the 9 patients with available margin status, 8 achieved R0 resection and 1 underwent R1 resection. Among cases with available complication data, postoperative complications occurred in 7 patients, including pleural effusion in 3 patients. Other complications included infectious bile leakage, small bowel perforation, and inferior vena cava obstruction or compression. One patient died on postoperative day 15 due to acute respiratory failure and renal failure secondary to hemopneumothorax. Overall survival ranged from 15 days to 76 months. Among patients with available follow-up data, tumor recurrence occurred in 3 patients, including 1 patient with confirmed bone metastasis, while the sites of recurrence in the remaining patients were not clearly reported. (2) Institutional experience: All 5 patients in our center achieved R0 resection. One patient died of acute liver failure postoperatively, and the remaining cases recovered well. Pleural effusion occurred in all patients postoperatively, but the length of hospital stay did not exceed 3 weeks in any case. One patient had early postoperative recurrence and died at 27 months, while the other 3 patients remained alive at the last follow-up(2025/9/30). Conclusions: ERAT may serve as a potential surgical option for selected patients with unresectable CRLM, and radical resection can be expected under strict patient selection criteria.

Central venous pressure (CVP) is a fundamental hemodynamic parameter in critically ill neonates, yet its invasive measurement poses technical challenges and risks, particularly in those receiving mechanical ventilation. The inferior vena cava (IVC) diameter and distensibility index (DI), as assessed by bedside ultrasound, have emerged as potential non‑invasive surrogates, but their quantitative relationship with CVP remains inadequately characterized in mechanically ventilated neonates across different ventilator modes. In this single-center prospective observational study, 62 neonates receiving mechanical ventilation who had an internal jugular central venous catheter inserted, admitted to the NICU in Maternal and Child Health Hospital of Hubei Province from January 2023 to December 2024, were enrolled. CVP, IVC-Dmax, IVC-Dmin, and IVC-DI were recorded in addition to the ventilator modes and settings for each measurement. CVP was significantly positively correlated with IVC-Dmax (Pearson's r = 0.823, 95% confidence interval [CI]: 0.722-0.890, P < 0.001) and IVC-Dmin (Pearson's r = 0.879, 95% CI: 0.812-0.924, P < 0.001), while a moderate negative correlation was observed between CVP and IVC-DI (Pearson's r = -0.428, 95% CI: -0.614 to -0.207, P < 0.001). A comparison of different ventilatory modes showed that neonates receiving high-frequency oscillatory ventilation (HFOV) had significantly higher CVP and IVC diameters, but a significantly lower IVC-DI. In contrast, neonates receiving pressure-controlled assist/control (PC-AC) ventilation had significantly lower CVP and IVC diameters, but a significantly higher IVC-DI. Ultrasonographic measurements of the IVC correlate with invasively measured CVP in mechanically ventilated neonates and may serve as a non-invasive alternative for CVP monitoring when invasive catheterization is contraindicated or unavailable. In ventilated neonates, IVC diameter demonstrates a strong positive correlation with CVP (r ≈ 0.8-0.9), whereas the distensibility index exhibits a moderate negative correlation (r ≈ -0.4). This first prospective study quantifies the CVP-IVC relationship specifically in newborns, reveals that HFOV independently elevates both CVP and IVC diameter while suppressing distensibility, and provides regression models (R² = 0.69 for diameter, 0.41 for distensibility index) that estimate CVP within ±1.2 mmHg. Bedside IVC ultrasound serves as a non‑invasive alternative for CVP monitoring when invasive catheterization is contraindicated or unavailable.

To evaluate inferior vena cava (IVC) filter utilization among trauma patients with regard to national trends, interhospital variation, and association with outcomes. IVC filters can be placed for therapeutic or prophylactic indications. Current clinical guidelines recommend IVC filter placement only for trauma patients with a proximal deep vein thrombosis (DVT) or pulmonary embolism (PE) and contraindication to anticoagulation. We performed a study using American College of Surgeons Trauma Quality Improvement Program data from 2017-2024. Inclusion criteria were adult patients, admitted to a Level I or II trauma center, with blunt or penetrating injury, hospital length of stay ≥3 days, and an Injury Severity Score ≥9. Hospital-level IVC filter insertion rates were calculated, and trauma centers were classified as low (<1%) or high (≥1%) utilizers. Risk-adjusted hospital-level outcomes were generated using mixed-effects logistic regression with empirical Bayes shrinkage. Associations between hospital-level IVC filter utilization and mortality, DVT, PE, and venous thromboembolism (VTE) were evaluated using Pearson correlation coefficients. Among 2,277,066 patients, at 427 trauma centers, 18,415 (0.81%) underwent IVC filter placement. Utilization declined from 1.15% in 2017 to 0.59% in 2024 (P<0.001). Substantial interhospital variation was found, with 96 trauma centers (22.5%) demonstrating rates of IVC filter insertion ≥1% (range, 0%-11.5%). Higher hospital-level IVC filter use was not associated with risk-adjusted in-hospital mortality (r=0.01, P=0.77) but was associated with increased rates of DVT (r=0.28), PE (r=0.20), and VTE (r=0.30) (all P<0.001). Although rates of IVC filter use in trauma patients has declined, marked interhospital variation exists. A higher rate of IVC filter utilization was not associated with improved survival. This suggests an opportunity to measure and optimize appropriate IVC filter use across trauma centers.

BackgroundHeterotaxy syndrome—polysplenia variant (left isomerism) with dextrocardia is a rare constellation of laterality defects characterized by left‐isomerism, multiple splenic nodules, and associated vascular and visceral anomalies. This report describes an adult Ethiopian woman who presented with nonspecific abdominal pain and was found to have imaging features diagnostic of heterotaxy (polysplenia variant).Case PresentationA 36‐year‐old Ethiopian female presented with a three‐day history of mild to moderate, nonradiating anterior abdominal pain. Physical examination revealed the apical impulse on the right and mild left upper quadrant tenderness. Contrast‐enhanced CT of the chest and abdomen demonstrated dextrocardia with the cardiac apex directed to the right, right‐sided aortic arch, interrupted inferior vena cava with azygos continuation, bilobed lungs consistent with left isomerism, multiple splenic nodules clustered in the left upper quadrant (polysplenia), and a short pancreas. Routine laboratory tests were unremarkable. The final diagnosis was heterotaxy syndrome—polysplenia variant (left isomerism) with dextrocardia. The patient was managed conservatively for presumed costochondritis, counseled about her anatomical variation, advised to carry a medical alert card, and remained symptom‐free at two‐week follow‐up.ConclusionImaging features in this patient are most consistent with heterotaxy syndrome (polysplenia variant) rather than isolated situs inversus totalis. Clear, consistent diagnostic terminology (heterotaxy—polysplenia variant with dextrocardia) is essential for accurate communication, appropriate counseling, and safe planning of future interventions. Recognition of such cases in underreported regions supports improved diagnostic awareness and tailored care.