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Lauener S, Bütikofer A, Eigenheer S, Escher R. Thrombophlebitis hiding under a KILT - case report on 40 years long-term follow-up of neonatal renal vein thrombosis. BMC Pediatr 2019; 19:183. [PMID: 31170948 PMCID: PMC6551889 DOI: 10.1186/s12887-019-1567-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 05/31/2019] [Indexed: 12/15/2022] Open
Abstract
Background Neonatal renal vein thrombosis is a recognised cause of renal and inferior caval vein atresia (IVCA). However, the long-term impact of the condition is underrecognized with a high burden of morbidity for the patient, especially in adulthood. IVCA has been shown to be an independent risk factor for deep venous thrombosis (DVT) with a high risk of recurrence. The acronym KILT for kidney and inferior vena cava anomaly with leg thrombosis summarizes the pathological situation. Case presentation We present the case of a 40-year-old patient with pain in the right lower limb resulting from acute thrombophlebitis. No risk factors could be identified. His history was remarkable with two episodes of deep venous thrombosis first of the left, then the right leg 22 years earlier; at that time also, no risk factor was identified. Because of the idiopathic character of that thrombosis, the patient remained on long-term anticoagulation with phenprocoumon. The present thrombophlebitis occurred while the INR was not therapeutic in the preceding weeks. A CT with contrast showed atresia of the inferior vena cava and of the right kidney, and presence of numerous collaterals. A thorough medical history revealed a renal vein thrombosis as a neonate. Anticoagulation was intensified, and stent placement became necessary after a further 2 years. Discussion and conclusions KILT syndrome is a rare but underrecognized condition. Complications may arise in young adulthood only, and it is of prime importance to instruct parents of the pediatric patient of the possible consequences of renal vein thrombosis and to assure guidance from the treating physicians throughout adulthood. Diagnosis of IVCA is by CT with contrast or by MRI, and lifelong anticoagulation may be necessary. Since the KILT syndrome is widely underdiagnosed, we challenge the clinicians to keep it in mind when confronted with thrombophlebitis or thrombosis of the young, male and with no other identifiable risk factors for deep vein thrombosis.
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Affiliation(s)
- Stefan Lauener
- Department of Medicine, Spital Emmental, Burgdorf, Switzerland
| | - Anne Bütikofer
- Department of Medicine, Spital Emmental, Burgdorf, Switzerland
| | | | - Robert Escher
- Department of Medicine, Spital Emmental, Burgdorf, Switzerland.
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Pichon M, Hij A, Wifaq B, Abderrahmane M, El Jarrari M, Menn AM. [Deep venous thrombosis caused by congenital inferior vena cava agenesis]. JOURNAL DE MEDECINE VASCULAIRE 2019; 44:79-85. [PMID: 30770086 DOI: 10.1016/j.jdmv.2018.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 11/18/2018] [Indexed: 06/09/2023]
Abstract
Congenital agenesis of the inferior vena cava, although rare, is found preferentially in young patients with proximal deep venous thrombosis. Exact diagnosis can be made thanks to enhanced computed tomography scan and/or magnetic resonance imaging, while Doppler ultrasonography is insufficient to establish an inferior vena cava malformation. A consensus has not yet been established for the treatment but lifelong anticoagulation with elastic stocking support to prevent post-thrombotic syndrome is commonly considered in most cases. We report a case of an unprovoked deep venous thrombosis caused by a congenital agenesis of the inferior vena cava localized to the infrarenal segment, in a 24-year-old man. An anticoagulation with low molecular weight heparin was started and prolonged oral anticoagulation was prescribed. In the absence of the usual thrombotic risk factors, the presence of an inferior vena cava anomaly should be considered.
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Affiliation(s)
- M Pichon
- Service de médecine polyvalente, centre hospitalier Victor-Dupouy, 69, rue du Lieutenant-Colonel Prudhon, 95100 Argenteuil, France.
| | - A Hij
- Service de médecine interne et pathologie vasculaire, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - B Wifaq
- Service de médecine polyvalente, centre hospitalier Victor-Dupouy, 69, rue du Lieutenant-Colonel Prudhon, 95100 Argenteuil, France
| | - M Abderrahmane
- Service de médecine polyvalente, centre hospitalier Victor-Dupouy, 69, rue du Lieutenant-Colonel Prudhon, 95100 Argenteuil, France
| | - M El Jarrari
- Service de radiologie, centre hospitalier Victor-Dupouy, 69, rue du Lieutenant-Colonel Prudhon, 95100 Argenteuil, France
| | - A-M Menn
- Service de médecine polyvalente, centre hospitalier Victor-Dupouy, 69, rue du Lieutenant-Colonel Prudhon, 95100 Argenteuil, France
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Thein OS, Braganza Menezes DA, Moran E. Pyrexia of unknown origin: inferior vena cava agenesis. BMJ Case Rep 2018; 2018:bcr-2018-224739. [PMID: 29936445 DOI: 10.1136/bcr-2018-224739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 26-year-old woman presented with a 5-day history of fever after returning from Bali. She denied sexual contact abroad. On examination, there was suprapubic tenderness and a widespread maculopapular rash. Malaria serology was negative and blood tests were normal except for an elevated C reactive protein. Treatment was initially with ceftriaxone, metronidazole and doxycycline, but her symptoms failed to improve. A CT pelvis suggested a possible tubo-ovarian abscess, a suspected inferior vena cava (IVC) anomaly and left internal iliac/femoral venous thrombosis. A gynaecology review demonstrated left tubo-ovarian tenderness and fullness. An MRI suggested pelvic inflammatory disease and thrombophlebitis affecting the pelvic veins; deep vein thrombosis (DVT) treatment was commenced. Further family history revealed thrombosis throughout multiple generations. Further imaging analysis demonstrated agenesis of the IVC with compensatory dilation of pelvic collaterals and an acute DVT of the deep pelvic venous system. The patient was discharged with direct oral anticoagulant therapy.
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Affiliation(s)
- Onn Shaun Thein
- Respiratory Medicine, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Darryl A Braganza Menezes
- Department of Infectious Diseases and Tropical Medicine, Birmingham Heartlands Hospital, Heart of England NHS Hospital Trust, Birmingham, UK
| | - Ed Moran
- Department of Infectious Diseases and Tropical Medicine, Birmingham Heartlands Hospital, Heart of England NHS Hospital Trust, Birmingham, UK
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Congenital absence of the inferior vena cava with bilateral iliofemoral acute deep venous thrombosis. J Vasc Surg Cases Innov Tech 2016. [DOI: 10.1016/j.jvscit.2016.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Epperla N, Usoltseva N. Unprovoked deep venous thrombosis in a young adult associated with membranous obstruction of inferior vena cava. BMJ Case Rep 2014; 2014:bcr-2014-206214. [PMID: 25535222 DOI: 10.1136/bcr-2014-206214] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Unprovoked deep venous thrombosis (DVT) in young adults is an unusual phenomenon, but it is associated with significant morbidity. Developmental anomalies of the inferior vena cava (IVC) should be considered as a possible aetiological factor, and appropriate investigations should be performed to determine the conclusive diagnosis and necessary treatment plan. We report a case of spontaneous thrombosis of the IVC and bilateral iliac venous system in a young man, associated with membranous obstruction of the IVC. He was diagnosed using several different investigational techniques, and successfully treated with mechanical thrombectomy, thrombolysis therapy and anticoagulation.
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Affiliation(s)
- Narendranath Epperla
- Department of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Natalia Usoltseva
- Department of Internal Medicine, Cascade Skagit Health Alliance, Mount Vernon, Washington, USA
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Idiopathic thrombosis of the inferior vena cava and bilateral femoral veins in an otherwise healthy male soldier. Case Rep Med 2013; 2013:246201. [PMID: 24187556 PMCID: PMC3800672 DOI: 10.1155/2013/246201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2013] [Revised: 08/14/2013] [Accepted: 09/03/2013] [Indexed: 12/31/2022] Open
Abstract
Thrombosis of the inferior vena cava is less common than deep venous thrombosis of the lower extremities, particularly in the absence of an obvious congenital caval abnormality or hypercoagulable state. We present a case of IVC thrombosis in an otherwise healthy and active 28-year-old male soldier secondary to dehydration and venous webbing. IVC thrombosis is an uncommon and underrecognized condition; in this case, the patient's caval thrombosis was initially mistaken for acute back strain. Prompt recognition is necessary to minimize long-term sequelae.
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Tratamiento de la trombosis venosa profunda asociada a agenesia de vena cava inferior. Revisión de las anomalías de vena cava inferior. ANGIOLOGIA 2011. [DOI: 10.1016/j.angio.2011.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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O'Connor DB, O'Brien N, Khani T, Sheehan S. Superficial and deep vein thrombosis associated with congenital absence of the infrahepatic inferior vena cava in a young male patient. Ann Vasc Surg 2011; 25:697.e1-4. [PMID: 21724109 DOI: 10.1016/j.avsg.2011.02.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Revised: 02/18/2011] [Accepted: 02/24/2011] [Indexed: 11/25/2022]
Abstract
BACKGROUND Congenital absence of the inferior vena cava (AIVC) is a rare vascular anomaly that may be associated with deep vein thrombosis (DVT). It is underreported and may be present in up to 5% of young patients with DVT. We report a unique case of simultaneous thrombosis of both superficial and deep veins in a patient with AIVC. METHODS AND RESULTS A 20-year-old man presented with a 2-week history of a swollen, painful, left lower limb. On examination, the left leg and thigh were found to be swollen and varicosities were present along the lower abdominal wall. Ultrasound showed extensive superficial and deep venous thrombosis of the entire left lower limb. Computed tomography venogram revealed an infrahepatic AIVC with lower limb drainage through enlarged intrathoracic continuations of the azygous and hemiazygous veins. The patient was put on oral anticoagulant therapy and was well at 6-month follow-up. CONCLUSION The hypothesis for DVT in patients with AIVC is that venous drainage of the lower limbs is inadequate, leading to venous stasis and thrombosis. All young patients presenting with idiopathic DVT should be investigated for inferior vena cava anomalies with computed tomography if ultrasound does not visualize the inferior vena cava.
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Affiliation(s)
- Donal B O'Connor
- Department of Vascular Surgery, Saint Vincent's University Hospital, Dublin, Ireland.
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Broholm R, Jørgensen M, Just S, Jensen LP, Bækgaard N. Acute Iliofemoral Venous Thrombosis in Patients with Atresia of the Inferior Vena Cava Can Be Treated Successfully with Catheter-directed Thrombolysis. J Vasc Interv Radiol 2011; 22:801-5. [DOI: 10.1016/j.jvir.2011.01.449] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2009] [Revised: 01/11/2011] [Accepted: 01/26/2011] [Indexed: 11/29/2022] Open
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Lambert M, Marboeuf P, Midulla M, Trillot N, Beregi JP, Mounier-Vehier C, Hatron PY, Jude B. Inferior vena cava agenesis and deep vein thrombosis: 10 patients and review of the literature. Vasc Med 2010; 15:451-9. [PMID: 21183652 DOI: 10.1177/1358863x10391355] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Inferior vena cava agenesis (IVCA) is a rare condition, found in almost 5% of patients under 30 years old with unprovoked deep venous thrombosis (DVT). We describe 10 consecutive patients with IVCA-associated DVT and conducted an extensive literature review to investigate the typical spectrum of IVCA-associated DVT. Among our patients (eight men and two women; mean age, 25 ± 4.5 years), DVT followed intense and unusual (major) physical activity for eight of them. DVT was bilateral in six patients and unilateral in four. Ultrasonography was unable to detect IVCA, which was visualized by computed-tomography scans for seven patients, and magnetic resonance imaging and angiography for 10. Hereditary thrombophilia screening, to detect factor V Leiden or prothrombin gene heterozygosity (G20210A mutation), was positive for only two patients. Wearing elastic stockings and taking an indefinite or long-term vitamin K antagonist were prescribed for all 10 patients and nine complied with the latter. To date, 62 patients with IVCA-associated DVT have been reported in the English literature. Analysis of them and our patients yielded a typical spectrum of IVCA-associated DVT characteristics: IVCA occurs in young adults, particularly males, and is revealed by proximal DVT following major physical exertion. All were treated with a prolonged vitamin K antagonist and advised to wear elastic stockings. No precise duration of anticoagulation has been established.
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Affiliation(s)
- Marc Lambert
- Internal Medicine Department, Université Lille Nord de France, F-59037 Lille, France
| | - Philippe Marboeuf
- Vascular Medicine Department, Université Lille Nord de France, F-59037 Lille, France
| | - Marco Midulla
- Vascular Radiology Department, Université Lille Nord de France, F-59037 Lille, France
| | - Nathalie Trillot
- Hemostasis Laboratory, Centre Hospitalier Universitaire de Lille, Université Lille Nord de France, F-59037 Lille, France
| | - Jean-Paul Beregi
- Vascular Radiology Department, Université Lille Nord de France, F-59037 Lille, France
| | - Claire Mounier-Vehier
- Vascular Medicine Department, Université Lille Nord de France, F-59037 Lille, France
| | - Pierre-Yves Hatron
- Internal Medicine Department, Université Lille Nord de France, F-59037 Lille, France
| | - Brigitte Jude
- Hemostasis Laboratory, Centre Hospitalier Universitaire de Lille, Université Lille Nord de France, F-59037 Lille, France
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Absent inferior vena cava resulting in exercise-induced epidural venous plexus congestion and lower extremity numbness: a case report and review of the literature. Spine (Phila Pa 1976) 2010; 35:E921-4. [PMID: 21381233 DOI: 10.1097/brs.0b013e3181e83d6e] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Case report and clinical discussion. OBJECTIVE To describe a unique etiology for a patient presenting with exercise-induced lower extremity numbness found to have agenesis of the infrarenal inferior vena cava (IVC) and a large vein draining the confluence of the iliac veins through the L4 foramen into the epidural plexus. SUMMARY OF BACKGROUND DATA Epidural venous abnormalities are infrequently determined to be the etiology of nerve root compression syndromes. Such cases have been described in patients with absent IVC with thrombosis. We are unaware of any previously described cases of absent IVC with a primary route of venous return through the epidural venous plexus, resulting in symptoms in the absence of thrombosis. METHODS We describe a case of a 34-year-old man who presented complaining of numbness of legs as well as cauda equina symptoms occurring during exercise. He was found to have infrarenal absence of the IVC with the confluence of the iliac veins forming a large draining vein which entered the L4 foramen into the epidural venous plexus. Pre- and postexercise magnetic resonance imaging scans were performed to compare change in the size of the plexus. RESULTS Postexercise magnetic resonance imaging showed notable increase in the volume of the epidural venous plexus of the lower lumbar spine. The patient was referred to neurosurgery and vascular surgery, which did not intervene. On follow-up 2 years later, the patient developed significant right deep venous thrombosis and was found to be heterozygous for factor V Leiden mutation. CONCLUSION This case demonstrates the breadth of anatomic and physiologic understanding a clinician must draw on when approaching patients with nerve root compression symptoms. It is also pertinent to consider performing a hypercoagulable work-up in patients with vascular deformations, as this may prevent future thrombosis.
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Vasco PG, López AR, Piñeiro ML, Rivera JIG. Deep venous thrombosis caused by congenital inferior vena cava agenesis and heterozygous factor V Leiden mutation - a case report. Int J Angiol 2009; 18:147-9. [PMID: 22477517 DOI: 10.1055/s-0031-1278343] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
The unusual clinical presentation, importance of imaging techniques and role of low molecular weight heparin are described for an initial treatment of thrombosis in inferior vena cava agenesis associated with heterozygous factor V Leiden. The patient, a 36-year-old woman, presented to the emergency room with sudden onset of back pain, swelling of the legs and thighs, and claudication while walking. Abdominal ultrasonography was immediately ordered. Anomalies in vascular blood flow were detected. Computed tomography was performed, and initially showed a complete absence of the infrarenal segment of inferior vena cava caudally to the origin of both renal veins. Treatment with enoxaparin (1 mg/kg twice per day) was started. The patient was discharged and returned to her activities of daily living two weeks after admission. This vascular abnormality is mostly incidentally diagnosed in adults and only a few cases are described as being associated with thrombophilia.
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Clayburgh DR, Yoon JD, Cipriani NA, Ricketts PA, Arora VM. Clinical problem-solving. Collateral damage. N Engl J Med 2008; 359:1048-54. [PMID: 18768949 DOI: 10.1056/nejmcps0708994] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Arash Mohammadi Tofigh, Coscas R, Koskas F, Kieffer E. Surgical Management of Deep Venous Insufficiency Caused by Congenital Absence of the Infrarenal Inferior Vena Cava. Vasc Endovascular Surg 2008; 42:58-61. [DOI: 10.1177/1538574407306791] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Congenital absence of the inferior vena cava (CAIVC) is a rare vascular defect, commonly reported as a fortuitous finding because patients are typically asymptomatic of the condition itself but are symptomatic of associated conditions such as congenital heart disease, polysplenia, asplenia, and inversion of bowel viscera. The presence of CAIVC is probably underestimated because CAIVC may not be detected by compression B-mode ultrasonography. By use of computed tomography, we diagnosed a case of CAIVC in a young athletic patient with disabling venous stasis symptoms of the lower limbs. Venous prosthetic reconstruction of the infrarenal vena cava provided with early subsiding of edema and healing of stasis ulcers. An intracaval web was found as potentially responsible for the condition. We present and propose our surgical method for this rare disabling condition.
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Affiliation(s)
| | - Raphaël Coscas
- Service de Chirurgie Vasculaire, CHU Pitie-Salpêtrière, Paris, France
| | - Fabien Koskas
- Service de Chirurgie Vasculaire, CHU Pitie-Salpêtrière, Paris, France
| | - Edouard Kieffer
- Service de Chirurgie Vasculaire, CHU Pitie-Salpêtrière, Paris, France
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Evanchuk DM, Von Gehr A, Zehnder JL. Superficial venous thrombosis associated with congenital absence of the inferior vena cava and previous episode of deep venous thrombosis. Am J Hematol 2008; 83:250-2. [PMID: 17918250 DOI: 10.1002/ajh.21089] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Congenital malformations of the inferior vena cava (IVC) are uncommon and may be associated with an increased risk of venous thrombosis. We report the case of a man with congenital absence of the IVC and remote history of deep venous thrombosis who now presents with severe abdominal wall superficial thrombophlebitis. To our knowledge, this is the first report of a patient with IVC absence who has developed both deep and superficial venous thromboses.
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Affiliation(s)
- Darren M Evanchuk
- Division of Hematology, Stanford University School of Medicine, Stanford, California, USA
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Iqbal J, Nagaraju E. Congenital absence of inferior vena cava and thrombosis: a case report. J Med Case Rep 2008; 2:46. [PMID: 18269760 PMCID: PMC2262908 DOI: 10.1186/1752-1947-2-46] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2007] [Accepted: 02/12/2008] [Indexed: 02/03/2023] Open
Abstract
Introduction A congenitally absent Inferior Vena Cava (IVC) is a rare anomaly that is recognised to be associated with idiopathic Deep Venous Thrombosis (DVT), particularly in the young. It may not be apparent until later in life. Retrospectively, as discussed in this case, there can be clues indicating the presence of such an anomaly from a young age. However, it is not clear whether early recognition of this condition would affect the prognosis and treatment. Case presentation A 54 year old gentleman was admitted with 3 weeks of abdominal pain and localised swelling over the right flank. Examination revealed palpable 'snake-like' tortuous, tender lumps on the abdominal wall. Past history revealed chronic non-healing venous leg ulcers, and varicose veins necessitating varicose vein ligation at a very young age. The ulcers eventually needed skin grafting. During this, current admission he was investigated and diagnosed with Deep Vein Thrombosis (DVT). CT scan, performed to search for intra-abdominal cancer, revealed absence of the Inferior Vena Cava with extensive thrombosed collaterals of the superficial abdominal and azygous veins and a congenitally atrophic left kidney. Conclusion This is a case of one of the oldest patient described in the literature to be diagnosed with absence of the IVC. It is thought that IVC anomalies are under-diagnosed, and may be commoner than once believed. However there were vital clues in his previous medical history suspicious for an underlying venous anomaly. Idiopathic DVT in a relatively young person with a past history of chronic leg ulceration or varicose veins should be investigated for congenital anomalies of the IVC. This is best achieved by CT scan of the abdomen.
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Affiliation(s)
- Javaid Iqbal
- Dept Gastroenterology, Gastroenterology Unit, Blackpool Fylde and Wyre Hospitals NHS trust, Whinney Heys Road, Blackpool, Lancashire, UK.
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Epidural venous enlargements presenting with intractable lower back pain and sciatica in a patient with absence of the infrarenal inferior vena cava and bilateral deep venous thrombosis. Spine (Phila Pa 1976) 2007; 32:E688-91. [PMID: 17978646 DOI: 10.1097/brs.0b013e318158cf94] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Case report. OBJECTIVE To present a rare anomaly of the inferior vena cava associated with radicular pain and to illustrate its imaging characteristics. SUMMARY OF BACKGROUND DATA Irritation of the trigeminal nerve by vascular anomalies, resulting in neuralgia is a well-recognized entity. Recently, compression of peripheral nerve roots due to enlarged epidural venous plexus has been described as a possible cause of back and radicular pain, too. METHODS A 26-year-old man presented with acute exacerbation of lower back pain associated with radiculopathy down his left thigh. On radiologic workup, a prolapse of a lumbar intervertebral disc was ruled out, but agenesis of the infrarenal segment of the inferior vena cava was found, which has caused bilateral deep venous thrombosis. Venous flow was redirected mainly via enlarged lumbar epidural, ascending lumbar, and paravertebral veins. RESULTS No associated congenital heart or abdominal organ defects were found and screening for thrombophilia was negative. The patient was successfully treated with anticoagulation under which symptoms gradually resolved. CONCLUSION The authors believe that epidural venous enlargements should be considered as a cause of radicular and/or back pain in patients with anomalies of the inferior vena cava, because pathologic processes compressing nervous structures can cause pain.
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Gil RJ, Pérez AM, Arias JB, Pascual FB, Romero ES. Agenesis of the inferior vena cava associated with lower extremities and pelvic venous thrombosis. J Vasc Surg 2006; 44:1114-6. [PMID: 17098553 DOI: 10.1016/j.jvs.2006.06.021] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2006] [Accepted: 06/25/2006] [Indexed: 11/21/2022]
Abstract
The absence of the inferior vena cava is an uncommon congenital anomaly and can be misdiagnosed. We report a 14-year-old boy initially admitted as a result of a painful abdominal mass; after admission, he experienced a deep venous thrombosis in his left leg. Subsequent evaluation revealed the congenital absence of the entire inferior vena cava, with a cluster of thrombosed collateral veins in his right pelvis, corresponding to the abdominal mass. The recognition of this anomaly may be helpful in the event of differential diagnosis in retroperitoneal masses. In young patients with idiopathic deep venous thrombosis, an inferior vena cava anomaly should be considered.
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Affiliation(s)
- Roberto Jiménez Gil
- Servicio de Angiología y Cirugía Vascular, Hospital General Universitario de Alicante, Alicante, Spain.
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