Congenital absence of the inferior vena cava with bilateral iliofemoral acute deep venous thrombosis

Extensive deep venous thrombosis in a young male with absent infrarenal inferior vena cava

A previously well, independent 20-year-old man presented with a 4-day history of progressive left lower limb pain with associated phlegmasia cerulea dolens. Duplex venous ultrasound examination and computed tomography venogram revealed extensive deep vein thrombus from the left popliteal vein to abnormal venous vasculature proximally. Notably, no infrarenal inferior vena cava was detected, with distal venous return channeled through lumbar and visceral collateral channels into the azygous system. Treatment included systemic anticoagulation, catheter-directed thrombolysis, and prolonged therapeutic anticoagulation. In the absence of other risk factors, anatomical abnormalities should be considered in young, well patients presenting with lower limb venous thrombosis.

An unusual case of deep venous thrombosis in a young patient: congenital absence of the infrarenal portion of the inferior vena cava

Deep venous thrombosis (DVT) is a commonly encountered diagnosis in clinical practice with a variety of well-established risk factors. Congenital absence of the inferior vena cava (IVC) is an extremely rare but established risk factor for DVT. Patients who develop DVTs are at high risk of long-term complications, including DVT recurrence and post-thrombotic syndrome. Here we report a rare case of a 27-year-old female who presented with an extensive DVT of the right lower extremity secondary to complete absence of the infrarenal portion of the IVC, confirmed on computed tomography. There is little consensus regarding the appropriate management of this patient population, and a brief review of the current evidence follows.