Deep venous thrombosis complicating a congenital absence of the inferior vena cava

A rare cause of deep vein thrombosis: inferior vena cava agenesis

Inferior vena cava agenesis is a rare condition and is often misdiagnosed. This anomaly is asymptomatic in the majority of cases and is usually diagnosed during imaging tests carried out for other purposes. The most frequent manifestation is deep vein thrombosis (DVT) in lower limbs and anticoagulation therapy is the most frequent treatment option. Other techniques such as thrombolysis and venous bypass are also described. We report two cases diagnosed at our institution during the last year, both of which presented with an episode of DVT. We opted for indefinite anticoagulation therapy and both patients remain asymptomatic, after 1 year of surveillance in the first case and 6 months in the second, with no new episodes of DVT. Although it is not a life-threatening anomaly, it is important to make an appropriate diagnosis and provide treatment to improve the symptoms and quality of life of these patients.

Venous Thromboembolism in a Patient with Interrupted Inferior Vena Cava and Compressed Azygos Continuation: A Case Report and Review of Literature

We report an unusual case of a 40-year-old male patient who experienced painful swelling of the left lower limb that persisted for 1 week. Imaging modalities not only confirmed the diagnosis of acute iliofemoral venous thrombosis and pulmonary embolism (PE), but also an incidental finding of interrupted inferior vena cava (IVC). This congenital anomaly is uncommon but rarely associated with venous thromboembolism (VTE). The azygos continuation was compressed by the descending aorta against the 11^th thoracic vertebrae, which was identified as the cause of VTE. He was treated successfully with anticoagulation and compression therapy. The patient was discharged with lifelong oral Rivaroxaban and remained asymptomatic. In the literature, only 9 cases of interrupted IVC-associated PE were identified but none was due to significant venous compression.

Agenesis of the Intrahepatic Inferior Vena Cava: A Case Report and Literature Review

Anomalies of the inferior vena cava (IVC) are an uncommon finding in the general population. A wide range of IVC anomalies has been described in the literature, the majority of which lack clinical significance. Agenesis of the IVC (AIVC) is a rare anomaly of the IVC in the general population. This anomaly may involve either complete agenesis of the IVC or agenesis of a segment of the IVC. Agenesis of the suprarenal segment is the most commonly occurring variant, while agenesis of the infrarenal and hepatic segments is less common. Here we report a case of agenesis of the intrahepatic segment of the IVC.

Conservative treatment vs thrombus removal for Iliofemoral vein thrombosis in patients with congenital abnormalities of the inferior vena cava: a case report and systematic review of the literature

Congenital abnormalities of the Inferior Vena Cava (IVC) should be suspected in cases of Deep Venous Thrombosis (DVT), especially in young patients, with no other risk factors and apparent causes. Currently, there is no guidance regarding the management of such patients. We report a case of Iliofemoral vein thrombosis in a young patient with congenital absence of the IVC that was successfully treated with catheter-directed thrombolysis (CDT) and perform a systematic review of the literature to identify evidence about the epidemiology, clinical presentation, management, and prognosis of this rare cause of DVT. A total of 42 studies reporting on 56 cases were included in the review. The mean age of the patients at the presentation of their first DVT episode is 23.6 years, 83.9% of patients were males, conservative management with anticoagulation was used in 68% of the reported cases, and thrombolysis was used in 32% of the cases. Only 10.7% of patients presented with PE potentially justified by the abnormal anatomy of the deep veins which makes the propagation of thrombi into the pulmonary arteries less possible. Comparing the long-term outcomes of the two treatment groups; 42.3% of the patients treated conservatively vs 15.4% of the patients treated with thrombolysis developed chronic symptoms (residual heaviness, pain, swelling, and cramping). 11.5% of patients who received conservative treatment developed post-thrombotic syndrome. None of the patients treated with thrombolysis developed post-thrombotic syndrome. There were no procedure-related complications and thrombolysis was well tolerated by the entirety of the thrombolysis treatment group. Recurrence of DVT occurred in 13% of the patients treated conservatively and in 7.7% of patients treated with thrombolysis. Thrombus removal by means of thrombolysis is the recommended treatment and can offer excellent short and long-term results. Anticoagulation with NOACs may be prescribed for life to prevent recurrence or for at least 6 months and then reconsidered following further evaluation of patients' bleeding risk. It may be of value to organise an international registry for such patients. Guidelines issued by the relevant scientific societies will then be able to make a clear recommendation about the management of such patients.

A Literature Review and Case Series of DVT Patients with Absent IVC Treated with Thrombolysis

BACKGROUND

Congenital absence of the inferior vena cava is related to deep venous thrombosis (DVT) in 5% of cases with no other risk factors. DVT is normally diagnosed by Duplex, whereas computerized tomography or magnetic resonance imaging is required to visualize this absence, and so, it is often missed but ought to be considered in young patients. There are many existing cases in the literature illustrating this link, but these patients were often managed conservatively with anticoagulation.

CASE SERIES

We report five cases presenting with a DVT who were found to have an absent inferior vena cava after imaging and were treated successfully with thrombolysis and consequently managed with lifelong anticoagulation, between January 2014 and January 2019.

CONCLUSIONS

Anomalies of the inferior vena cava can cause unprovoked DVT. These anomalies are often incidental findings after CT but could change the management plan in these patients. Treatment can be with anticoagulants only, thrombolysis, thrombectomy, balloon angioplasty or stents, and long-term or lifelong anticoagulation to prevent DVT recurrence.

[Deep venous thrombosis caused by congenital inferior vena cava agenesis]

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.

A Pitfall in the Diagnosis of Bilateral Deep Vein Thrombosis in a Young Man

A 32-year-old man with a history of bronchial asthma was referred for low back pain and bilateral femur pain. Vascular sonography revealed bilateral deep vein thrombosis (DVT) from the femoral veins to the popliteal veins. Computed tomography revealed hypoplasia of the inferior vena cava (IVC) and dilated lumbar veins, ascending lumbar veins, and azygos vein as collaterals. There was no evidence of malignant neoplasm. The results of the thrombophilia tests were within normal limits. Hypoplasia of the IVC is a rare cause of DVT. This anomaly should be considered as a cause of bilateral and proximal DVT, in particular, in young patients without major risk factors.

The Typical Presentation Spectrum of Deep Vein Thrombosis Associated with Inferior Vena Cava Malformations

Congenital malformations of the inferior vena cava (IVC) are rare and underreported. They can be a risk factor for deep venous thrombosis (DVT) as a result of inadequate venous drainage of the lower extremities through collateral circulation. The significant number of cases reported in the literature highlights their importance, warranting investigating their existence in younger individuals with idiopathic DVT of the lower extremities and pelvic veins. In this systematic review, we depict the typical presentation of IVC malformations, their management, and the management of their associated DVT.

Successful Surgical Management of Pelvic Congestion and Lower Extremity Swelling Owing to Absence of Infrarenal Inferior Vena Cava

Absence of isolated infrarenal inferior vena cava (IVC) is a rare condition documented in only a few published cases and typically treated with anticoagulation. We herein describe successful surgical management of the isolated infrarenal IVC absence in a healthy 35-year-old woman who presented with disabling pelvic congestion. An ascending venogram showed the absence of infrarenal IVC with a large left ovarian vein draining pelvic collateral vessels to the normal left renal vein and suprarenal IVC. The patient was successfully treated with a common femoral vein to the suprarenal IVC bypass using a bifurcated polytetrafluoroethylene graft, with rapid symptom resolution, and remained symptom free 6 months later. This is the first reported case describing a surgical strategy for isolated infrarenal IVC absence in a symptomatic patient.

A Novel Technique of Ilio-Portal Venous Bypass to Relieve Symptoms of Pelvic Vein Congestion in a Patient with Inferior Vena Cava Agenesis

A 37 year old man known to have inferior vena cava agenesis, presented to our center with severe symptoms of pelvic venous congestion. Surgical approach was attempted by creating a bypass between the right external iliac vein and the portal vein using an autogenous venous bypass (superficial femoral vein). Over a three year follow up, the bypass remained patent with complete resolution of symptoms. The ilio-portal venous bypass suggests a surgical alternative that has not been previously described.

Incidental Finding of Inferior Vena Cava Atresia Presenting with Deep Venous Thrombosis following Physical Exertion

Inferior vena cava atresia (IVCA) is a rare but well described vascular anomaly. It is a rare risk factor for deep venous thrombosis (DVT), found in approximately 5% of cases of unprovoked lower extremity (LE) DVT in patients <30 years of age. Affected population is in the early thirties, predominantly male, often with a history of major physical exertion and presents with extensive or bilateral DVTs. Patients with IVC anomalies usually develop compensatory circulation through the collateral veins with enlarged azygous/hemizygous veins. Despite the compensatory circulation, the venous drainage of the lower limbs is often insufficient leading to venous stasis and thrombosis. We describe a case of extensive and bilateral deep venous thrombosis following physical exertion in a thirty-six-year-old male patient with incidental finding of IVCA on imaging.

An unusual occurrence: a case of venous thromboembolism in pregnancy associated with heterotaxy syndrome

BACKGROUND

Heterotaxy is a relatively uncommon congenital anomaly that is usually diagnosed incidentally on imaging studies in adults. We present an unusual case of venous thromboembolism in a 26 year old pregnant female with Heterotaxy syndrome.

CASE PRESENTATION

A 26 year-old pregnant female at 13 weeks gestation suffered cardiac arrest with successful cardiac resuscitation and return of spontaneous circulation. The cardiac arrest was secondary to massive pulmonary embolism requiring thrombolytic therapy and stabilization of hemodynamics. She had extensive evaluation to determine the etiology for the pulmonary embolism and was noted to have an anatomic variation consistent with heterotaxy syndrome on imaging studies. After thrombolysis the patient was treated with UFH and then switched to enoxaparin without complication until 25 weeks of gestation when she experienced worsening abdominal pain with associated headaches, lightheadedness and elevated blood pressures needing elective induction of labor. The infant died shortly after delivery. The anticoagulation was continued for additional 3 months and she was subsequently placed on low dose aspirin to prevent recurrent venous thromboembolic episodes. She is currently stable on low dose aspirin and is into her third year after the venous thromboembolism without any recurrence.

CONCLUSION

To our knowledge, this is the first reported case of venous thromboembolism in pregnancy associated with heterotaxy syndrome. A discussion on pathophysiology of venous thromboembolism in pregnancy and heterotaxy syndrome has been undertaken along with treatment approach in such situations.

Elevated risk of thrombophilia in agenesis of the vena cava as a factor for deep vein thrombosis

Background

Congenital absence of the inferior vena cava (AIVC) is a rare malformation which may be associated with an increased risk for deep vein thrombosis (DVT). However, the role of thrombophilia in AIVC and DVT is unknown.

Methods

Between 1982 and 2013 41 patients (12 female, 29 male, mean age 28 S.D. 11 years) were detected at the University of Düsseldorf, Germany, with AIVC. Based on medical history, clinical examination, imaging and coagulation studies, we performed on this collective a risk characterisation. Extensive literature research added further 123 published cases during 1993 and 2013. AIVC-patients were compared with iliocaval DVT-patients without AIVC (n = 168) treated during the same period in our clinic (90 female, 78 male, mean age 38 S.D. 17 years).

Results

In contrast to classical DVT younger men were more often affected. Factor-V-Leiden-mutation, 5,10-methylenetetrahydrofolate reductase (MTHFR) polymorphism and hyperhomocysteinemia individually are associated with an increased risk of DVT in patients with AIVC. Aplasia/hypoplasia of the right or left kidney is also associated with IVCA.

Conclusions

AIVC should be considered in young patients who present with DVT involving the vena cava. Analysis of publications with AIVC and our patients yielded a typical spectrum of AIVC-associated DVT characteristics: AIVC occurs in young male adults, is revealed by proximal DVT, not necessarily accused by precipitating factors like immobilisation, and is mostly located bilateral. Hereditary coagulation abnormalities seem to be more often a contributing factor for DVT in AIVC.

Electronic supplementary material

The online version of this article (doi:10.1186/s13023-014-0223-4) contains supplementary material, which is available to authorized users.

Unprovoked deep venous thrombosis in a young adult associated with membranous obstruction of inferior vena cava

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.

Dysgenesis of the inferior vena cava associated with deep venous thrombosis and a partial Protein C deficiency

Dysgenesis of the inferior vena cava is rare but it is being increasingly diagnosed by cross-sectional imaging techniques. Patients are usually asymptomatic with abnormalities detected incidentally. An 11 year old boy presented with a 10 day history of fever, vomiting and abdominal pain, which progressed to his back and lower limbs. Magnetic resonance imaging, computerised tomography and Doppler ultrasonography showed the absence of a suprarenal inferior vena cava with bilateral superficial femoral vein thrombi extending cranially to the end of the aberrant inferior vena cava. Haematological testing revealed a partial Protein C deficiency. The presenting clinical picture in this case is unique within the English literature and highlights that deep venous thrombosis associated with inferior vena cava dysgenesis may not present with typical symptoms in children. Early use of advanced imaging modalities would expedite diagnosis and subsequent treatment.

A rare cause of venous thrombosis: Congenital absence (agenesis) of the inferior vena cava

Deep vein thrombosis is a frequent finding in otherwise healthy, young adults who are diagnosed with congenital absence (agenesis) of the inferior vena cava - a rare anomaly. This condition is best diagnosed by computed tomography angiography with venous phase imaging, and is managed using anticoagulation, percutaneous catheter-directed mechanical thrombectomy and thrombolysis. To illustrate this phenomenon, a case is presented.

Efficacy of lower-extremity venous thrombolysis in the setting of congenital absence or atresia of the inferior vena cava

PURPOSE

A rare but described risk factor for deep venous thrombosis (DVT), predominantly in the young, is congenital agenesis or atresia of the inferior vena cava (IVC). The optimal management for DVT in this subset of patients is unknown. We evaluated the efficacy of pharmacomechanical catheter-directed thrombolysis (PCDT) followed by systemic anticoagulation in the treatment of acute lower-extremity DVT in the setting of congenital IVC agenesis or atresia.

MATERIALS AND METHODS

Between November of 2005 and May of 2010, six patients (three women [average age 21 years]) were referred to our department with acute lower-extremity DVT and subsequently found to have IVC agenesis or atresia on magnetic resonance imaging. A standardized technique for PCDT (the Angiojet Rheolytic Thrombectomy System followed by the EKOS Microsonic Accelerated Thrombolysis System) was used for all subjects. Successful thrombolysis was followed by systemic heparinization with transition to Coumadin or low molecular-weight heparin and compression stockings. Subjects were followed-up at 1, 3, and then every 6 months after the procedure with clinical assessment and bilateral lower-extremity venous ultrasound.

RESULTS

All PCDT procedures were technically successful. No venous stenting or angioplasty was performed. The average thrombolysis time was 28.6 h (range 12-72). Two patients experienced heparin-induced thrombocytopenia, and one patient developed a self-limited knee hemarthrosis, No patients were lost to follow-up. The average length of follow-up was 25.8 ± 20.2 months (range 3.8-54.8). No incidence of recurrent DVT was identified. There were no manifestations of postthrombotic syndrome.

CONCLUSIONS

PCDT followed by systemic anticoagulation and the use of compression stockings appears to be safe and effective in relatively long-term follow-up treatment of patients who present with acute DVT and IVC agenesis or atresia.

Superficial and deep vein thrombosis associated with congenital absence of the infrahepatic inferior vena cava in a young male patient

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.

Inferior vena cava agenesis and deep vein thrombosis: 10 patients and review of the literature

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.

Absent inferior vena cava resulting in exercise-induced epidural venous plexus congestion and lower extremity numbness: a case report and review of the literature

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.

Endovascular management of congenital atresia of the infrarenal IVC

This case illustrates the feasibility of endovascular treatment for chronic venous insufficiency attributable to congenital atresia of the infrarenal inferior vena cava (IVC). Three-dimensional computed tomography (CT) venography can elucidate alternate sites of drainage and identify other venous pathology, such as dominant stenoses that may be amenable to venoplasty and/or stent placement.

An adolescent with thigh pain

Musculoskeletal pain is a common symptom among active adolescent in the emergency department. The etiologic list is broad and range from benign to potential life-threatening conditions. Deep vein thrombosis is a rare cause of lower extremity pain in children. We report an adolescent who presented with lower extremity pain and a careful evaluation revealed an abdominal mass. Further investigation determined the presence of iliofemoral deep venous thrombosis and absence of the inferior vena cava. Absence of inferior vena cava is an uncommon congenital malformation in children and is a possible risk factor for the development of venous thrombosis. This case emphasizes the importance of thorough physical examination in children with nonspecific symptoms. If venous thrombosis is identified, especially in patients without any apparent risk factors, congenital anomalies of inferior vena cava should be considered. The pertinent literature is reviewed.

Abdominal pain: a presentation of a vena cava aplasia complicated by thrombosis

This case report describes a young man presenting with iliac fossa pain secondary to iliac vein thrombus due to inferior vena cava aplasia. No other identifiable risk factor or cause for deep vein thrombosis was demonstrated.

Congenital hypoplasia of the inferior vena cava and inherited thrombophilia: rare associated risk factors for idiopathic deep vein thrombosis. A case report

In young patients, acquired and genetic causes of deep vein thrombosis frequently interact. The association of congenital hypoplasia of the inferior vena cava with antithrombin III deficiency has never been described in the literature as a causal factor of proximal deep vein thrombosis in young patients. We report the case of an 18-year-old patient affected by deep vein thrombosis due to this rare association without other common risk factors.

Surgical Management of Deep Venous Insufficiency Caused by Congenital Absence of the Infrarenal Inferior Vena Cava

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.

Superficial venous thrombosis associated with congenital absence of the inferior vena cava and previous episode of deep venous thrombosis

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.

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

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.

Malformação de veia cava inferior e trombose venosa profunda: fator de risco de trombose venosa em jovens

A ausência da veia cava inferior, alteração no processo de formação embriológica que ocorre entre a sexta e a oitava semanas de gestação, é uma rara anomalia congênita. Porém, recentemente foi confirmada como sendo um fator de risco importante para o desenvolvimento de trombose venosa profunda, especialmente em jovens. Apresentamos um caso de trombose em veias cava inferior, ilíacas, femorais e poplíteas num jovem de 16 anos com agenesia de um segmento de veia cava infra-renal e veia renal esquerda retroaórtica.

Agenesis of the inferior vena cava associated with lower extremities and pelvic venous thrombosis

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.

Multiple and recurrent systemic thrombotic events associated with congenital anomaly of inferior vena cava

We describe a case of a 67-year-old woman with a history of cerebral infarction and pulmonary embolism that presented with chest pain. Subsequent evaluation resulted in a diagnosis of acute myocardial infarction and occult DVT, and imaging revealed a rare congenital absence of the infra-renal portion of the inferior vena cava, with lower extremity venous drainage diverted via an ascending lumbar vein. Associations between congenital absence of the inferior vena cava and thrombosis are discussed.

Deep venous thrombosis in a child associated with an abnormal inferior vena cava

Congenital anomalies of the inferior vena cava (IVC), such as absence or atresia, although well documented, are uncommon and result from aberrant development during embryogenesis. Absence or atresia of the IVC is usually discovered accidentally. Patients are typically asymptomatic of the condition itself. Many concurrent cardiovascular-associated abnormalities have been described. We report a 10-y-old boy admitted to the emergency room with painful swelling of his right lower limb without previous trauma or surgery. After 3 d, swelling also involved the left lower limb. A Doppler ultrasound of the lower limbs revealed bilateral thrombosis of the vena iliaca communis, vena iliaca externa, femoral vein communis and superficial extending to the IVC. Magnetic resonance imaging (MRI) of the abdomen was performed. On MRI, we demonstrated a hypoplastic IVC. The results of blood coagulation studies, including levels of antiphospholipid antibodies, proteins C and S, and antithrombin III, were normal. The patient was treated with intravenous heparin for 8 d and discharged with oral warfarin therapy, which has been recommended for life. Therapy against deep venous thrombosis must be focused on its prevention in the future. An abnormal inferior vena cava should be considered in young patients with deep venous thrombosis without apparent cause.

Deep venous thrombosis caused by congenital absence of inferior vena cava, combined with hyperhomocysteinemia

We present a case of suprarenal and infrarenal absence of the inferior vena cava, combined with hyperhomocysteinemia in a 39-year-old woman who presented with symptoms of deep venous thrombosis. The patient also had a homozygous mutation of C677T methylenetetrahydrofolate reductase. Deep vein thrombosis has a multifactorial etiology involving both genetic and acquired factors. Absence of the inferior vena cava is a rare congenital anomaly, but recently it was confirmed as an important risk factor for the development of deep vein thrombosis, especially in young persons. Hypercoagulability due to hyperhomocysteinemia with a tendency toward venous stasis, mediated by congenital absence of the inferior vena cava is thought to have caused deep vein thrombosis in our patient. To our knowledge, this association has not yet been reported. The clinical features and prognosis of the entity are discussed.

Developmental anomaly of the inferior vena cava

Despite the many possible modes of presentation, congenital anomalies of the inferior vena cava are increasingly being found in asymptomatic patients. Although plain chest radiography may reveal enough suggestive signs, the diagnosis is usually confirmed by ultrasound, computed tomography and magnetic resonance imaging. The authors present a case of infrarenal absence of the inferior vena cava that presented as a retroperitoneal mass and discuss the embryology and clinical implications of this unusual entity.

Congenital anomalies of the inferior vena cava revealed on CT in patients with deep vein thrombosis

OBJECTIVE

We describe a possible relationship between inferior vena cava anomalies and extensive thrombosis of the inferior vena cava and the iliac and femoral veins.

CONCLUSION

An anomaly of the inferior vena cava should be considered in young patients who present with deep vein thrombosis of the femoral and iliac veins. Coagulation abnormalities, frequently found in these patients, may be a contributory factor.

Recurrent deep venous thrombosis caused by congenital interruption of the inferior vena cava and heterozygous factor V Leiden mutation

A case of a 44-year-old patient with recurrent deep venous thrombosis (DVT) caused by congenital dysgenesis of the inferior vena cava (IVC) in coincidence with heterozygous factor V Leiden mutation is presented. The IVC malformation was a fortuitous finding because the vascular malformation of the collateral draining thoracic veins were suspected to be a malignant mass in chest X-ray. This vascular abnormality is a rare finding but recent epidemiological research suggests that there may be an association between the congenital absence of the IVC and DVT. In our case, the patient is even at higher risk combining the malformation probably affecting venous blood flow and the hypercoagulabilic state by heterozygous presence of the factor V Leidenmutation.

Venous Claudication in a Child with Thrombophilia

Deep venous thrombosis (DVT) rarely occurs in active children. Its presence usually suggests an inherited or acquired hypercoagulable state. Occasionally mechanical obstruction may be the inciting factor in this process. Initial management usually consists of sequential heparin and warfarin anticoagulation. We present the management of DVT in an adolescent girl with elevated levels of C-reactive protein and lupus anticoagulant. Venous claudication and severe lower-extremity swelling on ambulation complicated her course. After more than 2 weeks of conservative therapy with anticoagulation thrombolytic therapy was instituted. This was terminated early because of mild hematuria. However, follow-up duplex scan at 2 years has shown complete resolution of the iliofemoral thrombosis. Spontaneous DVT in children differ from that in adults in that an underlying etiology can usually be uncovered. These differences are explored.

Deep vein thrombosis caused by congenial interruption of the inferior vena cava--a case report

Congenital interruption of the inferior vena cava is an uncommon vascular anomaly. In this setting, the appearance of deep vein thrombosis is very rare because associated azygous or portal continuation develops as a collateral system for venous return. The authors present a case of infrahepatic interruption of the inferior vena cava in a 21-year-old man who presented with symptoms of deep vein thrombosis. Clinical features and prognosis of this entity are discussed.

Perinatal inferior vena cava thrombosis and absence of the infrarenal inferior vena cava

We report a case of infrarenal absence of the inferior vena cava (IVC) presenting as a major iliofemoral deep venous thrombosis in an adolescent. This is the first report of infrarenal IVC absence in which IVC thrombosis has been demonstrated in the perinatal period. We propose an association between perinatal IVC thrombosis and subsequent infrarenal IVC absence. In addition, the case demonstrates the importance of assessment for anatomical anomalies in patients presenting with apparently idiopathic deep venous thrombosis.