Purpose or Case Report: Congenital anomalies of the inferior vena cava (IVC) may easily be overlooked and present difficulties during abdominal and intravascular surgeries. Being aware of even the less common of these anatomical variations is essential. We present two cases of pre-aortic iliac confluence found incidentaly within the last year. The pre-aortic iliac confluence is described as a very rare variant with less than 50 reported cases within the last century. Also known as marsupial vena cava, it is a congenital anomaly of the development of the IVC in which the IVC is located anterior to the aortic bifurcation or the right common iliac artery. Both of the cases presented here coincide with additional congenital abnormalities which suggests an error of early embryogenesis may play a role in the development of this variant. Both of these cases were not identified on initial CT or MRI studies. It is possible that this variant is more common than previously thought but is often overlooked because of a lack of awareness of it's existance. Imaging findings on CT, with and without contrast, and MRI will be reviewed.
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