Aneurysm of the inferior vena cava complicated by thrombosis mimicking a retroperitoneal neoplasm

Treatment strategies for inferior vena cava aneurysms

OBJECTIVE

An inferior vena cava (IVC) aneurysm is a rare but potentially life-threatening entity. We successfully embolized an IVC aneurysm in a patient with history of blue rubber bleb nevus syndrome, a rare syndrome with multiple venous malformations. This new case was added to a literature review of previously reported cases, to analyze the management algorithm.

METHODS

A PubMed search for all English-language articles and abstracts of IVC aneurysm were conducted. A comprehensive descriptive analysis, including etiology, presentation, classification, comorbidities, and treatment options of our case joining all previously published cases, is presented and discussed.

RESULTS

Including our new case, a total of 74 (44 males) IVC aneurysms were analyzed. The average age was 39.0 ± 21.1 years (range, 0.4-89 years). Forty-nine (66.2%) were symptomatic; common symptoms include abdominal or back pain (24/74, 32.4%) and leg swelling or heaviness (20/74, 27.0%). Nineteen (19/59, 33.2%) were complicated with vena cava thrombosis, and 14 (14/59, 23.7%) were complicated with deep venous thrombosis of lower extremities. Thirty-two (43.2%) accepted surgical or endovascular intervention. There were 26 type I, 13 type II, 31 type III, and 4 type IV aneurysms. In type I group, 25 of 26 were treated conservatively, 2 deaths were reported. In type II group, 5 of 13 accepted conservative treatment. In type III group, 9 of 31 accepted conservative treatment, and 1 death was reported. In type IV group, 3 of 4 accepted conservative treatment, and 1 death was reported.

CONCLUSIONS

Conservative management can be conducted in type I and type IV groups with close surveillance. For type II and III groups, considering the high incidence of vena cava thrombosis and risk of rupture, more active treatment should be considered.

Multiple inferior vena cava aneurysms mimic a retroperitoneal tumor: a case report

BACKGROUND

Inferior vena cava (IVC) aneurysms are extremely rare with variable clinical manifestations. Patients are usually asymptomatic or present with complications of thrombosis and rupture. To date, there have been only a few reports of the condition in the literature, and diagnosis of IVC aneurysms may be difficult.

CASE PRESENTATION

A 33-year-old male patient presented to hospital because of a retroperitoneal mass found by computerized tomography during a health examination. He was asymptomatic, and post medical history and physical examination were unremarkable. Laboratory tests including tests for paraganglioma were all negative. Contrast-enhanced computed tomography scan revealed a stenosis of IVC in the suprarenal segment and two retroperitoneal mass on the right side of IVC. The larger one is about 3 cm in diameter and the smaller one is about 1 cm in diameter, which was considered as a retroperitoneal tumor with an enlarged lymph node. However, two IVC diverticular aneurysms were confirmed during the retroperitoneal laparoscopic exploration. The larger aneurysm was resected from the IVC successfully. Since the smaller aneurysm was about 1 cm in diameter without thrombosis, we did not resect it during surgery. The patient recovered well from surgery and discharged from our department successfully.

CONCLUSIONS

This is the first report of multiple IVC aneurysms. Because of the extremely low prevalence of IVC diverticular aneurysm, it may be misdiagnosed as other disease. Due to the high rate of thrombosis, surgical treatment especially retroperitoneal laparoscopy is recommended for small diverticular aneurysms.

Aneurysm of the inferior vena cava with thrombosis

Inferior vena cava (IVC) aneurysms are extremely rare. Patients can be asymptomatic, have thrombosis, rupture, or pulmonary embolism. Thrombosis of the IVC aneurysm may mimic a retroperitoneal tumor. Surgical treatment of abdominal venous aneurysms with thrombosis is warranted and is necessary for the management of intraoperative bleeding and thrombosis.

Symptomatic congenital saccular aneurysm of the inferior vena cava associated with a circumaortic left renal vein

Congenital saccular aneurysms of the inferior vena cava (IVC) are extremely rare, with 23 cases reported so far. We present a case of a 55-year-old woman with an acute episode of back pain that mimicked aortic dissection. Computed tomography ruled out aortic dissection but demonstrated a saccular aneurysm of the infrarenal IVC and a circumaortic left renal vein. The saccular aneurysm was excised, and the postoperative anatomopathologic examination revealed that it was congenital in nature. Surprisingly, preoperative symptoms of recurrent palpitations, dyspnea, and positional abdominal discomfort resolved after resection. This is the first reported case of a symptomatic congenital saccular aneurysm of the IVC with an associated circumaortic left renal vein.

Surgical management of a primary retroperitoneal venous aneurysm originating from the presacral venous plexus

Venous aneurysms are rare vascular abnormalities, and primary venous aneurysm originating from sacral venous plexus is exceedingly rare. In this article, we report a 28-year-old man with a large venous aneurysm (∼15 × 10 cm in size) originating from presacral venous plexus. The patient complained of 1 year of constant back pain associated with frequent defecation and urination, caused by the compression from the aneurysm. Exploratory laparotomy was performed for diagnosis, with successful aneurysmectomy to relieve the compression. The patient recovered uneventfully with complete relief of symptoms. Postoperative histopathologic examination manifested classic venous aneurysm. During follow-up 6 months after surgery, all symptoms were resolved without significant postoperative complications.

Aneurysmal dilatation of the inferior vena cava

AIM

Inferior vena cava aneurysms (IVCA) are rare, unlike aortic aneurysms. The diagnosis and treatment is challenging. This study defines clinical and echocardiographic findings in a prospective cohort of sixteen patients with fusiform IVCA.

METHODS AND RESULTS

All patients referred to the Mayo Clinic between January 2006 and July 2009 for a clinically indicated echocardiogram (36,128 patients) were screened for a dilated IVC. Sixteen cases of fusiform IVCA were identified. Eleven cases (68.8%) were female. Mean age at presentation was 76 years (range 51-89). Eleven (68.8%) had structural heart disease: with right ventricular (RV) dysfunction in 45.5% (n = 5), moderate or greater tricuspid regurgitation (TR) was seen in 36.4% (n = 4) and RV enlargement was seen in 18.2% (n = 2). The most common clinical indication for echocardiography was dyspnea (25%; n = 4) and heart failure (18.8%; n = 3). The mean IVCA diameter was 4.1 cm (range 3.8-5 cm) and the mean length of the aneurysms was 6.2 cm (range 3.5-8.7 cm), with mean right ventricular systolic pressure of 55 mmHg (range 31-105 mmHg). Five (31.3%) had at least a moderate reduction in right ventricular ejection fraction and five (31.3%) had significant TR. Among these five patients with significant TR, severe TR was present in 80%; (n = 4) and moderate to severe TR was present in 20%; (n = 1).

CONCLUSIONS

IVC aneurysms are more common in the elderly, and is associated with an increase in right sided heart pressures, significant TR, and RV dysfunction.

Inferior vena cava aneurysm

Aneurysms of the inferior vena cava (IVC) are exceedingly rare; less than 50 cases have been reported in the world literature. Owing to the paucity of data regarding the natural history of IVC aneurysms, there is no consensus on their treatment. This case report describes the evaluation of an IVC aneurysm in a 56-year-old male, briefly discusses the embryologic development of the IVC, and revisits the question of whether surgical intervention is indicated in these patients.

Aneurysm of the inferior vena cava: case report and review of the literature

Aneurysms of the inferior vena cava (IVC) are extremely rare. To the best of our knowledge, only 29 cases of IVC aneurysms are published in literature. We present a new case of surgically treated symptomatic saccular aneurysm of the infrarenal IVC and review previously published cases. Following resection of the aneurysm and the thrombosed infrarenal IVC, the patient fully recovered. Thrombosed IVC aneurysm may mimic a retroperitoneal tumour. In some cases, CT and MRI findings may be equivocal. Surgical treatment is indicated in all symptomatic and low-risk asymptomatic cases.

Haemodynamic assessment following inferior vena cava resection without replacement

BACKGROUND

Treatment of bulky retroperitoneal malignancy may require en bloc resection of the infrarenal inferior vena cava. A number of reconstructive options are available to the surgeon but objective haemodynamic assessment of the peripheral venous system following resection without replacement is lacking. The aim of the present paper was thus to determine the symptomatic and haemodynamic effects of not reconstructing the resected infrarenal inferior vena cava.

METHODS

A retrospective descriptive study was carried out at Princess Alexandra Hospital in Queensland. Five patients underwent resection of the thrombosed infrarenal inferior vena cava as part of retroperitoneal lymph node dissection for testicular cancer (n = 3), radical nephrectomy for renal cell carcinoma (n = 1) and thrombosed inferior vena cava aneurysm (n = 1). Clinical effects were determined via the modified venous clinical severity score and venous disability score. Haemodynamic data were obtained postoperatively using venous duplex ultrasound and air plethysmography.

RESULTS

None of the present patients scored >2 (out of 30) on the modified venous clinical severity score or >1 (out of 3) on the venous disability score. Haemodynamic studies showed only minor abnormalities.

CONCLUSIONS

Not reconstructing the resected thrombosed infrarenal inferior vena cava results in minor signs and symptoms of peripheral venous hypertension and only minor abnormalities on haemodynamic assessment.

Idiopathic aneurysm of inferior vena cava associated with retroperitoneal ganglioneuroma: case report

Idiopathic aneurysm of the inferior vena cava is rare. Many aneurysms are asymptomatic; others are diagnosed after complications develop. Ganglioneuroma is an infrequently occurring benign tumor preferentially located in the mediastinum and retroperitoneum. Generally the clinical manifestations are symptoms of compression related to growth of the mass. We present a case report of idiopathic aneurysm of the inferior vena cava associated with retroperitoneal ganglioneuroma. The tumor was resected in combination with a procedure to correct the aneurysm that has not previously been described, ie, tangential resection and primary lateral venorrhaphy. The technique provided excellent short-term results.

Aneurysm of the inferior vena cava in a 5-year-old boy

The authors present a case of an aneurysm of the inferior vena cava in a 5-year-old boy. The boy suffered from acute pulmonary and paradoxical cerebral embolism after a minor abdominal trauma. Magnetic resonance angiography was the key for correct diagnosis of the retroperitoneal process and helped develop a strategy for surgery. The boy underwent resection of the aneurysm and a prosthetic replacement of the distal inferior vena cava. Aneurysms of the inferior vena cava are very rare conditions. The diagnosis is difficult because they may mimic a retroperitoneal tumor. Thrombosis and embolism are common complications of aneurysms of the vena cava.