1
|
Kunow A, Freyer Martins Pereira J, Chenot JF. Extravertebral low back pain: a scoping review. BMC Musculoskelet Disord 2024; 25:363. [PMID: 38714994 PMCID: PMC11075250 DOI: 10.1186/s12891-024-07435-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 04/11/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Low back pain (LBP) is one of the most common reasons for consultation in general practice. Currently, LBP is categorised into specific and non-specific causes. However, extravertebral causes, such as abdominal aortic aneurysm or pancreatitis, are not being considered. METHODS A systematic literature search was performed across MEDLINE, Embase, and the Cochrane library, complemented by a handsearch. Studies conducted between 1 January 2001 and 31 December 2020, where LBP was the main symptom, were included. RESULTS The literature search identified 6040 studies, from which duplicates were removed, leaving 4105 studies for title and abstract screening. Subsequently, 265 publications were selected for inclusion, with an additional 197 publications identified through the handsearch. The majority of the studies were case reports and case series, predominantly originating from specialised care settings. A clear distinction between vertebral or rare causes of LBP was not always possible. A range of diseases were identified as potential extravertebral causes of LBP, encompassing gynaecological, urological, vascular, systemic, and gastrointestinal diseases. Notably, guidelines exhibited inconsistencies in addressing extravertebral causes. DISCUSSION Prior to this review, there has been no systematic investigation into extravertebral causes of LBP. Although these causes are rare, the absence of robust and reliable epidemiological data hinders a comprehensive understanding, as well as the lack of standardised protocols, which contributes to a lack of accurate description of indicative symptoms. While there are certain disease-specific characteristics, such as non-mechanical or cyclical LBP, and atypical accompanying symptoms like fever, abdominal pain, or leg swelling, that may suggest extravertebral causes, it is important to recognise that these features are not universally present in every patient. CONCLUSION The differential diagnosis of extravertebral LBP is extensive with relatively low prevalence rates dependent on the clinical setting. Clinicians should maintain a high index of suspicion for extravertebral aetiologies, especially in patients presenting with atypical accompanying symptoms.
Collapse
Affiliation(s)
- Anna Kunow
- Department of General Practice, University Medicine Greifswald, 17475, Fleischmannstraße, Greifswald, Germany.
| | | | - Jean-François Chenot
- Department of General Practice, University Medicine Greifswald, 17475, Fleischmannstraße, Greifswald, Germany
| |
Collapse
|
2
|
Agboola K, Chaurasia B, Scalia G, Umana GE, Montemurro N, Slinko E. Comprehensive insights into lumbar epidural varicose veins: Three clinical cases and surgical strategies. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2024; 15:205-209. [PMID: 38957759 PMCID: PMC11216636 DOI: 10.4103/jcvjs.jcvjs_9_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 03/10/2024] [Indexed: 07/04/2024] Open
Abstract
Lumbar epidural varicose veins (LEVs) present a challenging clinical scenario with limited literature. This series addresses the scarcity of comprehensive understanding, emphasizing the need for nuanced exploration. Varied prevalence estimates and clinical oversights underscore the urgency for a standardized approach to surgical interventions. We present three diverse clinical cases: (1) segmental varicose veins causing radicular pain, (2) local varicosities leading to lower paraparesis, and (3) widespread varicose veins with prolonged symptoms. Surgical tactics involved targeted coagulation, crossing of veins, and preservation of collateral blood flow. Advanced imaging techniques guided interventions. Tailoring interventions based on varicose vein subtype, preserving collateral flow, and adopting a staged postoperative approach contribute to successful outcomes. This series provides valuable insights into LEV management, emphasizing the significance of advanced imaging in diagnosis and surgical planning.
Collapse
Affiliation(s)
- Kayode Agboola
- Department of Neurosurgery, Romodanov Institute of Neurosurgery, National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine
| | - Bipin Chaurasia
- Department of Neurosurgery, Neurosurgery Clinic, Birgunj, Nepal
| | - Gianluca Scalia
- Department of Head and Neck Surgery, Neurosurgery Unit, Garibaldi Hospital, Catania, Italy
| | | | - Nicola Montemurro
- Department of Neurosurgery, Azienda Ospedaliera Universitaria Pisana (AOUP), Pisa, Italy
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Eugene Slinko
- Department of Spinal Pathologies, Romodanov Institute of Neurosurgery, National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine
| |
Collapse
|
3
|
Salgado-Parente A, Arévalo Galeano N, Almeida-Aróstegui N, Quiñones-Tapia D, López Parra MD, Acosta-Batlle J, Blázquez Sánchez J. Lumbar epidural vein thrombosis mimicking disc herniation: A report of 3 cases. Radiol Case Rep 2023; 18:4522-4527. [PMID: 37868005 PMCID: PMC10585626 DOI: 10.1016/j.radcr.2023.09.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 09/10/2023] [Accepted: 09/12/2023] [Indexed: 10/24/2023] Open
Abstract
Epidural vein thrombosis is a rare cause of lumbosciatica than can clinically and radiologically mimic other causes of nerve root compression such as disc herniation. We describe 3 unusual cases of spinal epidural plexus vein thrombosis illustrating the difficulty in preoperative diagnosis of this entity. Misinterpretation of imaging findings can lead to an erroneous diagnosis and inappropriate treatment. Knowledge of certain radiologic findings will increase the likelihood of recognizing epidural vein thrombosis.
Collapse
Affiliation(s)
| | | | | | | | | | - José Acosta-Batlle
- Radiology Department of the Ramon y Cajal University Hospital, Madrid, Spain
| | | |
Collapse
|
4
|
Saab K, Brahmandam AS, Brackett AL, Desai MM, Dardik A, Guzman RJ, Chaar CIO. Systematic review of inferior vena cava atresia. J Vasc Surg Venous Lymphat Disord 2023; 11:1253-1264. [PMID: 37453547 DOI: 10.1016/j.jvsv.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 06/30/2023] [Accepted: 07/01/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE Inferior vena cava (IVC) atresia is a rare venous anomaly characterized by absence of the IVC. It has been associated with deep vein thrombosis (DVT) and other congenital anomalies. The aim of the present study is to provide a comprehensive summary of the literature on IVC atresia and discuss the presentation and outcomes of patients with IVC atresia. METHODS A systematic review of the English literature up to April 2020 was performed. The presentations and treatments reported were noted and compared between the two sexes. The IVC atresia cases were further stratified into isolated IVC atresia and IVC atresia associated with other congenital anomalies. RESULTS A total of 412 abstracts were screened, with 178 reports included. A total of 376 patients were analyzed. Overall, males seem to be more affected than females, with a ratio of almost 2:1 (male, 227 [64.1%]; vs female, 127 [35.8%]). However, females were more likely to have congenital IVC atresia compared with males (46.1% vs 21.3%; P < .001). The mean age at presentation was 27.9 ± 18.0 years (range, 0-77 years), with no differences between the sexes. Most patients with IVC atresia presented with DVT (n = 242 of 376; 64.3%), with the iliac veins most often affected (n = 159 of 242; 65.7%). No difference was found in the reported proportion of patients presenting with DVT between the two sexes. The symptom presentation was similar, with leg pain and swelling the most common in both sexes. The patients were treated either medically with anticoagulation or surgically (open or endovascular). No mortality was reported with isolated IVC atresia in either treatment group. However, the mortality of patients with IVC atresia associated with other congenital anomalies was 11.7%. CONCLUSIONS IVC atresia is more common in males but seems to have a predilection for females in the setting of other congenital anomalies. Most patients present with leg pain and swelling related to the development of DVT. Open and endovascular surgical interventions to treat IVC atresia have been reported in 18.3% of patients reviewed, with acceptable mid-term results in terms of patency and symptomatic relief.
Collapse
Affiliation(s)
- Karim Saab
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Anand S Brahmandam
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Alexandria L Brackett
- Clinical Research and Education, Harvey Cushing/John Hay Whitney Medical Library, Yale University School of Medicine, New Haven, CT
| | - Mayur M Desai
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT
| | - Alan Dardik
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Raul J Guzman
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Cassius Iyad Ochoa Chaar
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale School of Medicine, New Haven, CT.
| |
Collapse
|
5
|
Kwan KJ, Li HL, Chan YC, Huang JX, Cui DZ, Cheng SW. Venous Thromboembolism in a Patient with Interrupted Inferior Vena Cava and Compressed Azygos Continuation: A Case Report and Review of Literature. Vasc Endovascular Surg 2023:15385744231165213. [PMID: 36922360 DOI: 10.1177/15385744231165213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
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 11th 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.
Collapse
Affiliation(s)
- Kristine Js Kwan
- International School, 47885Jinan University, Guangzhou, China.,Division of Vascular Surgery, Department of Surgery, 444333The University of Hong Kong - Shenzhen Hospital, China
| | - Hai-Lei Li
- Division of Vascular Surgery, Department of Surgery, 444333The University of Hong Kong - Shenzhen Hospital, China
| | - Yiu Che Chan
- Division of Vascular Surgery, Department of Surgery, 444333The University of Hong Kong - Shenzhen Hospital, China.,Division of Vascular and Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, China
| | - Jian-Xiong Huang
- Division of Vascular Surgery, Department of Surgery, 444333The University of Hong Kong - Shenzhen Hospital, China
| | - Dong-Zhe Cui
- Division of Vascular Surgery, Department of Surgery, 444333The University of Hong Kong - Shenzhen Hospital, China
| | - Stephen Wk Cheng
- Division of Vascular Surgery, Department of Surgery, 444333The University of Hong Kong - Shenzhen Hospital, China.,Division of Vascular and Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, China
| |
Collapse
|
6
|
Cavalerie R, Jolivet F, Launay M, Baudin Tréhiou C, Piazza S. Cervical vertebral veins and caudal cerebral sinuses thrombosis secondary to corticosteroid therapy for an immune‐mediated polyarthritis in a dog. VETERINARY RECORD CASE REPORTS 2023. [DOI: 10.1002/vrc2.587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Affiliation(s)
- Robin Cavalerie
- Neurology Department Centre Hospitalier Vétérinaire Languedocia Montpellier France
| | - Franck Jolivet
- Internal Medicine Department Centre Hospitalier Vétérinaire Languedocia Montpellier France
| | - Maheva Launay
- Diagnostic Imaging Department Centre Hospitalier Vétérinaire Languedocia Montpellier France
| | - Clément Baudin Tréhiou
- Diagnostic Imaging Department Centre Hospitalier Vétérinaire Languedocia Montpellier France
| | - Stéphanie Piazza
- Neurology Department Centre Hospitalier Vétérinaire Languedocia Montpellier France
| |
Collapse
|
7
|
Lui DH, Williamson HM, Hamilton G, Drebes A, Davies N, Lim CS. Lower Limb Weakness due to Spinal Venous Congestion in Chronic Inferior Vena Cava Occlusion: A Case Report. Vasc Endovascular Surg 2023; 57:175-181. [PMID: 36189730 DOI: 10.1177/15385744221131202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
CASE REPORT A 31 year-old male presented with a long history of reduced sensation and motor function in his lower limbs upon waking every morning, lasting 30-50 minutes during which he was unable to ambulate. He was involved in a severe road traffic accident as a child, and was born prematurely requiring prolonged neonatal hospitalisation. Both duplex ultrasonography and magnetic resonance venography identified an occlusion of the IVC, with patent common femoral and iliac veins draining into large spinal collaterals. No other cause was identified for his symptoms. After appropriate multidisciplinary team discussion and patient counselling, the patient proceeded to have endovenous recanalization of his IVC and common iliac veins with dedicated venous stents. Post-operatively, the patient reported an immediate resolution of neurological symptoms, with an improvement in quality of life questionnaire scores and with stent patency at 9-month follow up. CONCLUSION IVC occlusion with symptomatic spinal venous congestion is a rare condition which may be successfully treated with endovascular iliocaval recanalization, although long-term outcomes of this treatment are still unknown.
Collapse
Affiliation(s)
- Dennis H Lui
- Department of Vascular Surgery, 4965Royal Free Hospital, UK.,Division of Surgery and Interventional Science, 919University College London, UK
| | | | - George Hamilton
- Department of Vascular Surgery, 4965Royal Free Hospital, UK.,Division of Surgery and Interventional Science, 919University College London, UK
| | - Anja Drebes
- Department of Haematology, 4965Royal Free Hospital, UK
| | - Neil Davies
- Department of Interventional Radiology, 4965Royal Free Hospital, UK
| | - Chung S Lim
- Department of Vascular Surgery, 4965Royal Free Hospital, UK.,Division of Surgery and Interventional Science, 919University College London, UK
| |
Collapse
|
8
|
Role of Inferior Vena Cava (IVC) Recanalization in Patients with Back Pain, Secondary to IVC Obstruction in Budd-Chiari Syndrome. Diagnostics (Basel) 2023; 13:diagnostics13030438. [PMID: 36766542 PMCID: PMC9914368 DOI: 10.3390/diagnostics13030438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 01/19/2023] [Accepted: 01/24/2023] [Indexed: 01/27/2023] Open
Abstract
PURPOSE To study the prevalence of back pain in patients of Budd-Chiari syndrome (BCS) with inferior vena cava (IVC) obstruction, and to evaluate the role of IVC recanalization in resolution of back pain. METHODS All patients with BCS and IVC obstruction who underwent IVC recanalization between January 2018 and October 2022 were included. Patients with degenerative spine disease or other identifiable causes for back pain were excluded; remaining patients were assessed for the presence of back pain. In patients with back pain, pain relief was assessed at 24 h following IVC recanalization. RESULTS Fifty-eight patients with BCS and IVC occlusion were identified, of which six with degenerative spine diseases were excluded. Of the remaining 52 patients, 34 (65.4%) had back pain, with pain score between 3 and 9. Engorged epidural venous plexus on preprocedural imaging (p = 0.002), and degree of luminal narrowing (p = 0.021) had a significant association with back pain. Twenty-nine of thirty-four patients (85.3%) with back pain had pain relief immediately following IVC recanalization, more so in patients with engorged epidural venous plexus on preprocedural imaging (p < 0.001). CONCLUSION Back pain is one of the under-reported symptoms of IVC obstruction in BCS. IVC recanalization by IVC angioplasty with or without stenting relieves back pain due to the decompression of engorged epidural veins.
Collapse
|
9
|
Koudounas G, Giannopoulos S, Volteas P, Virvilis D. A unique case of hypoplastic inferior vena cava leading to bilateral iliofemoral venous outflow obstruction and review of literature. J Vasc Surg Cases Innov Tech 2022; 8:842-849. [PMID: 36561354 PMCID: PMC9763364 DOI: 10.1016/j.jvscit.2022.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 10/17/2022] [Indexed: 11/07/2022] Open
Abstract
Venous thromboembolism (VTE) is a common cardiovascular disease associated with high rates of morbidity and mortality whereas it induces substantial health care costs and increased use of resources. The current standard of treatment for acute deep vein thrombosis (DVT) is anticoagulation, although revascularization can be considered in younger patients with severe symptoms and extensive thrombus burden to prevent long-term sequalae of VTE (eg, recurrent DVTs, post-thrombotic syndrome post-pulmonary embolism syndrome, and chronic thromboembolic pulmonary hypertension). A rare cause of VTE is anomalous development of the inferior vena cava (IVC) and can challenge endovascular revascularization. This case report describes a case of hypoplastic supra hepatic IVC, associated with distal IVC occlusion and bilateral lower extremity DVTs treated successfully with suction thrombectomy and on table only thrombolysis, avoiding the higher risk for major bleeding, intensive care unit admission and prolonged hospitalization associated with prolonged tissue plasminogen activator infusion.
Collapse
Affiliation(s)
| | | | | | - Dimitrios Virvilis
- Correspondence: Dimitrios Virvilis, MD, Stony Brook University Hospital, 101 Nicolls Rd, Stony Brook, NY 11794
| |
Collapse
|
10
|
Venous congestion as a central mechanism of radiculopathies. Joint Bone Spine 2021; 89:105291. [PMID: 34653602 DOI: 10.1016/j.jbspin.2021.105291] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 09/29/2021] [Indexed: 01/12/2023]
Abstract
Compression of roots/nerves can disrupt some of their functions, but does not necessarily cause pain. This is illustrated by the frequency of nearly asymptomatic spinal stenosis or disc herniations. In fact, pain of radiculopathies (and nerve entrapments) may mostly be the consequence of intraneural oedema induced by microscopical venous stasis around roots/spinal ganglia (or nerves) not or poorly shown by imaging. This narrative review first lists arguments for a role of congestion of vasa-nervorum in the pathophysiology of radiculopathies, including those induced by disc herniation and spinal stenosis, but also other sources of overpressures in spinal venous plexuses (pregnancy, vena cava atresia and thrombosis, portal hypertension, epidural varices, arterio-venous fistula, vertebral hemangioma or hemangioblastoma). It also details sources of venous congestion around nerves outside the spine, from pelvis (May-Thurner syndrome, Nut-cracker syndrome) to buttocks (superior and inferior gluteal veins), and even thighs and legs. A better recognition of a preeminent role of venous congestion in radiculopathies, plexopathies, and nerve entrapments, should have major consequences: (i) discard the dogma that compression is mandatory to induce root/nerve suffering, since root/nerve adherences in two locations can impair blood flow in vasa-nervorum through root/nerve stretching; (ii) implementation of sensitive techniques to visualise impingement of blood flow around or within roots and nerves; (iii) better prevention of roots/nerves adherence, or arachnoiditis induced by extravascular fibrin deposition secondary to venous stasis.; (iv) optimizing treatments dampening clot formation and/or extravascular fibrin leakage in the intradural/peridural spaces, or around roots/nerves, like guided injection of tissue plasminogen activator.
Collapse
|
11
|
Ferrer P, Álvarez AS, Khalil S. Gastric balloon: A rare cause of lumbar radiculopathy. Surg Neurol Int 2021; 12:398. [PMID: 34513164 PMCID: PMC8422450 DOI: 10.25259/sni_656_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 07/17/2021] [Indexed: 11/15/2022] Open
Abstract
Background: Factors that are known to cause lumbar epidural venous plexus (EVP) engorgement include inferior vena cava (IVC) obstruction, portal hypertension, vascular agenesis, morbid obesity, and/or hypercoagulable states. Here, we present a 32-year-old female admitted with the new onset of lumbar radiculopathy attributed to a gastric balloon causing compression of the IVC and engorgement of the EVP. Case Description: A 32-year-old female was admitted with a left L5 radiculopathy. She had a history of morbid obesity and had undergone intragastric balloon insertion 4 months ago. The abdominal/pelvic CT documented an intragastric balloon producing a voluminous gastric mass with resultant compression of the IVC. The lumbar MRI showed the resultant marked multilevel engorgement of the lumbar EVP. Here, following balloon removal, the patient was immediately symptom free and remained asymptomatic over the next postoperative year. Conclusion: An intragastric balloon can produce a voluminous gastric mass that can result in IVC occlusion and engorgement of the EVP, leading to lumbar radiculopathy. Removal of the balloon results in immediate and permanent resolution of the compressive symptoms.
Collapse
Affiliation(s)
- Pierre Ferrer
- Department of Neurosurgery, Gomez Ulla Central Defence Hospital
| | - Ana Sofía Álvarez
- Department of Neurosurgery, Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | - Sara Khalil
- Department of Neurosurgery, Fundación Jiménez Díaz University Hospital, Madrid, Spain
| |
Collapse
|
12
|
Campione A, Agresta G, Locatelli D, Pozzi F. Cauda equina syndrome secondary to portal vein thrombosis: case report of favorable outcome with conservative treatment. J Neurosurg Spine 2021. [DOI: 10.3171/2020.7.spine20625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Epidural varicosis is a rare though well-known cause of cauda equina syndrome (CES). Although inferior vena cava (IVC) obstruction is the most common finding in such cases, portal vein hypertension can lead to epidural venous plexus engorgement by means of lumbar portocaval shunt activation.
A 40-year-old woman presented with right-sided sciatica, which progressed to right foot drop and a 3-day history of vesical tenesmus and fecal retention. She was initially diagnosed with L4–5 lumbar disc protrusion. However, contrast-enhanced lumbar MRI scan showed the presence of epidural varices in the L3–S1 tract. Given the absence of vascular anomalies amenable to resection, etiological conservative treatment was addressed. Therefore, a complete diagnostic workup was performed and revealed deep vein thrombosis (DVT), pulmonary embolism, and portal vein thrombosis. Oral anticoagulant therapy was initiated and prompt resolution of CES was observed. To the authors’ knowledge, this is the first report of CES secondary to epidural varicosis in the setting of acute portal vein thrombosis and extrahepatic portal vein obstruction (EHPVO). In cases of epidural varicosis, conservative etiological treatment is the most appropriate choice as CES may be the epiphenomenon of underlying systemic pathophysiological processes.
Collapse
Affiliation(s)
- Alberto Campione
- Department of Neurosurgery, Ospedale di Circolo Fondazione Macchi—ASST Settelaghi; and
- Department of Neurosurgery, Università degli Studi dell’Insubria, and
| | - Gianluca Agresta
- Department of Neurosurgery, Ospedale di Circolo Fondazione Macchi—ASST Settelaghi; and
| | - Davide Locatelli
- Department of Neurosurgery, Ospedale di Circolo Fondazione Macchi—ASST Settelaghi; and
- Department of Neurosurgery, Università degli Studi dell’Insubria, and
- Head and Neck Surgery & Forensic Dissection Research Center, Department of Biotechnology and Life Sciences, Università degli Studi dell’Insubria, Varese, Italy
| | - Fabio Pozzi
- Department of Neurosurgery, Ospedale di Circolo Fondazione Macchi—ASST Settelaghi; and
- Department of Neurosurgery, Università degli Studi dell’Insubria, and
- Head and Neck Surgery & Forensic Dissection Research Center, Department of Biotechnology and Life Sciences, Università degli Studi dell’Insubria, Varese, Italy
| |
Collapse
|
13
|
Inferior vena cava anomalies: review and surgical considerations. ANGIOLOGIA 2021. [DOI: 10.20960/angiologia.00282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
|
14
|
Campione A, Agresta G, Locatelli D, Pozzi F. Cauda equina syndrome secondary to portal vein thrombosis: case report of favorable outcome with conservative treatment. J Neurosurg Spine 2021:1-6. [PMID: 33386000 DOI: 10.3171/2020.6.spine20625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 07/31/2020] [Indexed: 11/06/2022]
Abstract
Epidural varicosis is a rare though well-known cause of cauda equina syndrome (CES). Although inferior vena cava (IVC) obstruction is the most common finding in such cases, portal vein hypertension can lead to epidural venous plexus engorgement by means of lumbar portocaval shunt activation.A 40-year-old woman presented with right-sided sciatica, which progressed to right foot drop and a 3-day history of vesical tenesmus and fecal retention. She was initially diagnosed with L4-5 lumbar disc protrusion. However, contrast-enhanced lumbar MRI scan showed the presence of epidural varices in the L3-S1 tract. Given the absence of vascular anomalies amenable to resection, etiological conservative treatment was addressed. Therefore, a complete diagnostic workup was performed and revealed deep vein thrombosis (DVT), pulmonary embolism, and portal vein thrombosis. Oral anticoagulant therapy was initiated and prompt resolution of CES was observed. To the authors' knowledge, this is the first report of CES secondary to epidural varicosis in the setting of acute portal vein thrombosis and extrahepatic portal vein obstruction (EHPVO). In cases of epidural varicosis, conservative etiological treatment is the most appropriate choice as CES may be the epiphenomenon of underlying systemic pathophysiological processes.
Collapse
Affiliation(s)
- Alberto Campione
- 1Department of Neurosurgery, Ospedale di Circolo Fondazione Macchi-ASST Settelaghi; and
- 2Department of Neurosurgery, Università degli Studi dell'Insubria, and
| | - Gianluca Agresta
- 1Department of Neurosurgery, Ospedale di Circolo Fondazione Macchi-ASST Settelaghi; and
| | - Davide Locatelli
- 1Department of Neurosurgery, Ospedale di Circolo Fondazione Macchi-ASST Settelaghi; and
- 2Department of Neurosurgery, Università degli Studi dell'Insubria, and
- 3Head and Neck Surgery & Forensic Dissection Research Center, Department of Biotechnology and Life Sciences, Università degli Studi dell'Insubria, Varese, Italy
| | - Fabio Pozzi
- 1Department of Neurosurgery, Ospedale di Circolo Fondazione Macchi-ASST Settelaghi; and
- 2Department of Neurosurgery, Università degli Studi dell'Insubria, and
- 3Head and Neck Surgery & Forensic Dissection Research Center, Department of Biotechnology and Life Sciences, Università degli Studi dell'Insubria, Varese, Italy
| |
Collapse
|
15
|
Carpenter K, Decater T, Iwanaga J, Maulucci CM, Bui CJ, Dumont AS, Tubbs RS. Revisiting the Vertebral Venous Plexus-A Comprehensive Review of the Literature. World Neurosurg 2020; 145:381-395. [PMID: 33049379 DOI: 10.1016/j.wneu.2020.10.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 09/30/2020] [Accepted: 10/01/2020] [Indexed: 12/23/2022]
Abstract
The venous drainage of the vertebral and paravertebral regions is important for a better understanding of hematogenous disease spread. Moreover, the spine surgeon must be well acquainted with this anatomy to minimize intraoperative and postoperative complications. A comprehensive review of the vertebral venous plexus (Batson plexus) was performed with a concentration on the clinical and surgical correlations of this venous network.
Collapse
Affiliation(s)
- Kennedy Carpenter
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, Louisiana, USA
| | - Tess Decater
- Department of Anatomical Sciences, St. George's University, St. George's, Grenada, West Indies
| | - Joe Iwanaga
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Neurology, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA; Division of Gross and Clinical Anatomy, Department of Anatomy, Kurume University School of Medicine, Kurume, Fukuoka, Japan.
| | - Christopher M Maulucci
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - C J Bui
- Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, Louisiana, USA
| | - Aaron S Dumont
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - R Shane Tubbs
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Neurology, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Structural and Cellular Biology, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, Louisiana, USA; Department of Anatomical Sciences, St. George's University, St. George's, Grenada, West Indies
| |
Collapse
|
16
|
Hallan DR, McNutt S, Reiter GT, Thamburaj K, Specht CS, Knaub M. Dilated Epidural Venous Plexus Causing Radiculopathy: A Report of 2 Cases and Review of the Literature. World Neurosurg 2020; 144:231-237. [PMID: 32961358 DOI: 10.1016/j.wneu.2020.09.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 08/23/2020] [Accepted: 09/08/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND A dilated epidural venous plexus (DEVP) is a rare cause of radiculopathy, back pain, cauda equina syndrome, and other neurological symptoms. This vascular mass can be secondary to inferior vena cava obstruction, portal hypertension, vascular agenesis, and hypercoagulable states. Although rare, DEVP should be considered in the differential diagnosis for patients who present with lumbar radiculopathy. CASE DESCRIPTION We present 2 cases involving patients with lumbar DEVP as well as a literature review of the role of hypercoagulability, vascular anatomy, and inferior vena cava thrombosis in the development of DEVP. The first patient had a history of recurrent deep vein thrombosis, systemic lupus erythematosus, and antiphospholipid syndrome. The diagnosis of DEVP was determined after intraoperative biopsy. The patient reported symptom resolution at her 6-month postoperative appointment. The second patient developed DEVP associated with Klippel-Trenaunay syndrome. She presented with back pain and leg weakness, and DEVP was diagnosed via magnetic resonance imaging. A neurosurgeon is currently following the patient. We believe this is the first case of Klippel-Trenaunay syndrome associated with DEVP. CONCLUSIONS If a patient presents with an enhancing epidural lesion on magnetic resonance imaging and neurological symptoms, DEVP should be considered in the differential diagnosis. Additionally, a search for inferior vena cava thrombosis should be performed as well as risk factors for venous hypertension and hypercoagulable states.
Collapse
Affiliation(s)
- David R Hallan
- Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA.
| | - Sarah McNutt
- Department of Pennsylvania State College of Medicine, Hershey, Pennsylvania, USA
| | - G Timothy Reiter
- Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Krishnamoorthy Thamburaj
- Department of Neuroradiology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Charles S Specht
- Department of Pathology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Mark Knaub
- Department of Orthopaedic Surgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| |
Collapse
|
17
|
Zhang X, Chen H, Feng L, Cai Y, Yin W, Hu X, Liu C. Central venous catheters misplaced in paraspinal veins: A systematic literature review based on case reports. Nurs Crit Care 2020; 26:262-273. [PMID: 32869464 DOI: 10.1111/nicc.12539] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/29/2020] [Accepted: 08/02/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND Paraspinal vein misplacement is an uncommon complication of central venous catheterization via lower extremities, most of which have been reported in case reports. AIM To determine the clinical characteristics of paraspinal vein misplacement. DESIGN This was a systematic review. METHODS A systematic literature search in the PubMed, EMBASE, Scopus, and Web of Science databases was performed from their inception to 18 June 2019. Case reports and small case series describing central venous catheter misplacement in the paraspinal vein were included. Data on the catheterization procedure, catheter tip position, complications, and radiographic features of misplacement were extracted. RESULTS Thirty studies with a total of 36 patients were included. The ascending lumbar vein accounted for the majority of misplacements (n = 30), followed by the lumbar vein (n = 4), iliolumbar vein (n = 1), and vertebral venous plexus (n = 1). Six patients had eventful catheterization procedures. Twenty-six patients experienced misplacement-induced complications, of whom seven died. The most common complications included cerebrospinal fluid abnormalities, neurological symptoms, and deteriorated respiration. Among the entire case cohort, the onset of complications was the primary sign that alerted medical staff to misplacement (n = 23). The typical radiographic characteristics were posterior deviation of the catheter course overlapping with the spine on lateral X-rays and a bend, kink, or hump in the catheter course on anteroposterior X-rays at the L4 to L5 levels. CONCLUSIONS Nurses should be aware of this particular complication if a patient who has undergone catheterization via a lower extremity presents deterioration of neurological function and respiration. RELEVANCE TO CLINICAL PRACTICE Lateral X-ray radiography is an effective method to verify misplacement and is recommended as routine practice during catheterization via lower extremities.
Collapse
Affiliation(s)
- Xiaoxia Zhang
- West China School of Nursing/Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Hongxiu Chen
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Liwei Feng
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Yujia Cai
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Wanhong Yin
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Xiuying Hu
- Innovation Center of Nursing Research, West China School of Medicine/West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Chang Liu
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| |
Collapse
|
18
|
Jeong HJ, Sim WS, Park HJ, Lee SH, Oh MS, Cho MK, Seon HJ, Lee JY. Severe lumbar radiculopathy with epidural venous plexus engorgement in a morbidly obese pediatric patient: A case report. Medicine (Baltimore) 2019; 98:e16842. [PMID: 31415408 PMCID: PMC6831412 DOI: 10.1097/md.0000000000016842] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Engorgement of the epidural venous plexus (EVP) is a rare cause of nerve root impingement. Dilated epidural veins cause compression of the thecal sac and spinal nerve roots, leading to lumbar radiculopathy. PATIENT CONCERNS Here we describe a case of severe lumbar radiculopathy in a 15-year-old morbidly obese boy. DIAGNOSIS Enhanced lumbar magnetic resonance imaging revealed left sided L1-L2 disc protrusion and engorgement of the lumbar EVP, resulting in narrowing of the thecal sac in the entire lumbar spine. There was no evidence of an intra-abdominal mass, thrombosis of the inferior vena cava, or vascular malformation. INTERVENTIONS A caudal epidural block was administered under fluoroscopic guidance. The patient reported a 30% reduction in pain intensity for just 1 day. OUTCOMES The patient has been followed up for 2 years. He continues to take medication, including morphine sulfate 15 mg, gabapentin 300 mg, and oxycodone 20 mg per day. He is on a diet with exercise for weight reduction. CONCLUSION An engorged EVP should be considered in the differential diagnosis of radiculopathy in morbidly obese patients.
Collapse
Affiliation(s)
- Hee Joon Jeong
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, School of Medicine, Sungkyunkwan University
| | - Woo Seog Sim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, School of Medicine, Sungkyunkwan University
| | - Hue Jung Park
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seung Hwan Lee
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Min Seok Oh
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, School of Medicine, Sungkyunkwan University
| | - Min Kyoung Cho
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, School of Medicine, Sungkyunkwan University
| | - Heui Jin Seon
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, School of Medicine, Sungkyunkwan University
| | - Jin Young Lee
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, School of Medicine, Sungkyunkwan University
| |
Collapse
|
19
|
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.
Collapse
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
| |
Collapse
|
20
|
Reis EP, Silva Junior NA, Appenzeller S, Reis F. Radicular compression syndrome after exercise in a young patient: not everything is a herniated disk! Radiol Bras 2018; 51:408-409. [PMID: 30559561 PMCID: PMC6290755 DOI: 10.1590/0100-3984.2017.0080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
| | | | | | - Fabiano Reis
- Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brazil
| |
Collapse
|
21
|
Morosetti D, Picchi E, Calcagni A, Lamacchia F, Cavallo AU, Bozzi A, Lacchè A, Sergiacomi G. Anomalous development of the inferior vena cava: Case reports of agenesis and hypoplasia. Radiol Case Rep 2018; 13:895-903. [PMID: 29997719 PMCID: PMC6037009 DOI: 10.1016/j.radcr.2018.04.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 04/09/2018] [Accepted: 04/13/2018] [Indexed: 11/15/2022] Open
Abstract
We reported the cases of two adult male patients who were admitted to our emergency room with abdominal pain and dyspnea caused by gallstones and pulmonary embolism respectively. During the radiological investigations, as collateral findings, we found two anomalous development of the inferior vena cava. These conditions affect about 4% of population and, although asymptomatic or mildly symptomatic, are associated with thrombotic manifestations as deep vein thrombosis and pulmonary embolism. The prompt recognition of these anomalies is necessary in order to prevent the complications associated with these conditions and to set the best therapy for patients.
Collapse
Affiliation(s)
- Daniele Morosetti
- Department of Diagnostic and Molecular Imaging, Interventional Radiology and Radiotherapy, University Hospital of Rome "Tor Vergata", Viale Oxford 81, 00133 Rome, Italy
| | - Eliseo Picchi
- Department of Diagnostic and Molecular Imaging, Interventional Radiology and Radiotherapy, University Hospital of Rome "Tor Vergata", Viale Oxford 81, 00133 Rome, Italy
| | - Antonello Calcagni
- Department of Diagnostic and Molecular Imaging, Interventional Radiology and Radiotherapy, University Hospital of Rome "Tor Vergata", Viale Oxford 81, 00133 Rome, Italy
| | - Feliciana Lamacchia
- Department of Diagnostic and Molecular Imaging, Interventional Radiology and Radiotherapy, University Hospital of Rome "Tor Vergata", Viale Oxford 81, 00133 Rome, Italy
| | - Armando Ugo Cavallo
- Department of Diagnostic and Molecular Imaging, Interventional Radiology and Radiotherapy, University Hospital of Rome "Tor Vergata", Viale Oxford 81, 00133 Rome, Italy
| | - Alessio Bozzi
- Department of Diagnostic and Molecular Imaging, Interventional Radiology and Radiotherapy, University Hospital of Rome "Tor Vergata", Viale Oxford 81, 00133 Rome, Italy
| | - Adriano Lacchè
- Department of Diagnostic and Molecular Imaging, Interventional Radiology and Radiotherapy, University Hospital of Rome "Tor Vergata", Viale Oxford 81, 00133 Rome, Italy
| | - Gianluigi Sergiacomi
- Department of Diagnostic and Molecular Imaging, Interventional Radiology and Radiotherapy, University Hospital of Rome "Tor Vergata", Viale Oxford 81, 00133 Rome, Italy
| |
Collapse
|
22
|
Wong TW, Gridley DG, Feiz-Erfan I. Epidural venous plexus engorgement due to inferior vena cava thrombosis resulting in cauda equina syndrome: Case report and literature review. Surg Neurol Int 2018; 9:129. [PMID: 30105127 PMCID: PMC6044142 DOI: 10.4103/sni.sni_115_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 05/18/2018] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Epidural venous plexus congestion at L5-S1 due to inferior vena cava (IVC) thrombosis led to an acute cauda equina syndrome (CES). Laminectomy to rule out an epidural abscess, allowing for resection of the dilated veins, led to immediate symptom resolution. CASE DESCRIPTION A 47-year-old male presented with acute urinary retention and left greater than right lower extremity paresis of 2 weeks duration. Magnetic resonance imaging (MRI) revealed a contrast-enhancing space-occupying anterior epidural L5-S1 level lesion resulting in cauda equina compression. As the patient was septic, he underwent an emergency laminectomy for a presumed epidural abscess. Intraoperative findings, however, documented a markedly dilated epidural venous plexus secondary to a newly diagnosed IVC thrombus. One day postoperatively, the patient was symptom-free and neurologically intact. CONCLUSIONS Here we report a patient who uniquely presented with a CES characterized by acute paraparesis. This was attributed to a massively engorged anterior lumbar epidural venous plexus attributed to newly diagnosed IVC thrombus.
Collapse
Affiliation(s)
- Tina W. Wong
- Department of Surgery, Division of Neurosurgery, University of Arizona College of Medicine – Phoenix, Maricopa Medical Center, Phoenix, Arizona, USA
| | - Daniel G. Gridley
- Department of Radiology, University of Arizona College of Medicine – Phoenix, Maricopa Medical Center, Phoenix, Arizona, USA
| | - Iman Feiz-Erfan
- Department of Surgery, Division of Neurosurgery, University of Arizona College of Medicine – Phoenix, Maricopa Medical Center, Phoenix, Arizona, USA
| |
Collapse
|
23
|
Yamamoto K, Gondo G, Ogino H, Watanabe T, Tanaka M, Tanaka S, Kawasaki T. Sciatic Neuralgia Caused by May-Thurner Syndrome. World Neurosurg 2018; 116:40-43. [PMID: 29772369 DOI: 10.1016/j.wneu.2018.05.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 05/04/2018] [Accepted: 05/05/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Sciatic neuralgia (SN) is a type of pain commonly associated with lumbosacral radiculopathy. May-Thurner syndrome (MTS) is a disease characterized by venous congestion in the left common iliac vein (LCIV) due to right common iliac artery compression. A case of MTS with SN as the first presenting symptom is described. CASE DESCRIPTION A 53-year-old man gradually developed left SN; however, radiologic examination showed no causal findings. Conservative medical treatment did not result in satisfactory pain relief. During the follow-up period, edema and brownish skin pigmentation were noted on the left crural region. Follow-up magnetic resonance imaging of lumbar spine revealed vascular enlargement around the spine and compression of the LCIV by the right common iliac artery. Furthermore, the left S1 nerve root was compressed by enlarged veins, which was thought to be the cause of the left S1 radiculopathy and SN. After the stenosed part of the LCIV was expanded, the pain and edema in the left leg disappeared. CONCLUSIONS This is the first report of SN associated with MTS. MTS should be considered as one of the differential diagnoses of SN. Thus, symptoms such as pain, edema, and skin hyperpigmentation on the left leg should be closely noted.
Collapse
Affiliation(s)
- Kazuaki Yamamoto
- Department of Neurosurgery, Shonan Kamakura General Hospital, Kamakura, Japan.
| | - Gakuji Gondo
- Department of Neurosurgery, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Hidemitsu Ogino
- Division of Vascular Surgery, Department of Surgery, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Tsuyoshi Watanabe
- Department of Neurosurgery, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Masahiko Tanaka
- Department of Neurosurgery, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Satoshi Tanaka
- Department of Neurosurgery, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Taisuke Kawasaki
- Department of Neurosurgery, Shonan Kamakura General Hospital, Kamakura, Japan
| |
Collapse
|
24
|
Im IK, Son ES, Kim DH. Lumbar Epidural Varix Causing Radicular Pain: A Case Report and Differential Diagnosis of Lumbar Cystic Lesions. PM R 2018; 10:1283-1287. [PMID: 29705169 DOI: 10.1016/j.pmrj.2018.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 04/06/2018] [Accepted: 04/11/2018] [Indexed: 10/17/2022]
Abstract
Lumbar epidural varices are a rare cause of radicular pain mimicking lumbar disc herniation or other cyst-like masses including sequestrated disc herniation, facet joint synovial cyst, or perineural cyst. We report a case of a 36-year-old woman presenting with lumbar radicular pain caused by a lumbar epidural varix. Lumbar magnetic resonance imaging (MRI) revealed a cystic lesion in the ventral epidural space posterior to the right L4 body. Surgery was conducted and histopathology confirmed the diagnosis of an epidural varix. Lumbar epidural varices and other lumbar cystic lesions can commonly cause radicular pain. Physicians will benefit from increased awareness of epidural varices as a cause of lumbosacral radicular pain and the associated radiologic findings supporting differential diagnosis. In particular, careful interpretation of MRI scans may help ensure proper diagnosis of an epidural varix versus other cystic lesions. LEVEL OF EVIDENCE: V.
Collapse
Affiliation(s)
- Il-Kyu Im
- Department of Rehabilitation Medicine, Dongsan Medical Center, School of Medicine, Keimyung University, Daegu, South Korea(∗)
| | - Eun-Seok Son
- Department of Orthopaedic surgery, Dongsan Medical Center, School of Medicine, Keimyung University, Daegu, South Korea(†)
| | - Du Hwan Kim
- Department of Rehabilitation Medicine, Dongsan Medical Center, School of Medicine, Keimyung University, 56 Dalseong-ro, Jung-gu, Daegu 700-712, South Korea(‡).
| |
Collapse
|
25
|
Vernon JC, Durand A, Guevar J, José-López R, Hammond G, Stalin C, Gutierrez-Quintana R. Vertebral venous system abnormalities identified with magnetic resonance imaging in sighthounds. Vet Radiol Ultrasound 2017; 58:399-410. [PMID: 28337816 DOI: 10.1111/vru.12492] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Revised: 12/16/2016] [Accepted: 12/20/2016] [Indexed: 11/30/2022] Open
Abstract
In humans, abnormalities of the vertebral venous system are considered rare but significant causes of radiculopathy and myelopathy. Published information on abnormalities of the canine vertebral venous system is currently lacking. Aims of this retrospective descriptive study were to characterize magnetic resonance imaging (MRI) abnormalities of the vertebral venous system in a population of sighthounds, report prevalence of vertebral venous system abnormalities within that population and explore possible clinical significance. Our hospital database was searched over the period of 2002-2013 for sighthounds with MRI studies of the vertebral column. Medical records and MRI studies for included dogs were retrieved and findings were recorded by a single observer. A total of 92 sighthounds were sampled. Eleven cases (prevalence 12%) showed abnormal enlargement of the internal vertebral venous plexus (10/11 unilaterally, 1/11 bilaterally), external vertebral venous plexus (7/11 cases unilaterally), and/or intervertebral veins (8/11 unilaterally, 2/11 bilaterally, and 1/11 unilaterally and bilaterally at different sites). The majority of the abnormalities were right sided and the most common location for abnormalities was C6/7. Of the 11 cases, nine did not have a definitive diagnosis. Seven of those nine cases had an abnormality in a neuroanatomical localization that could wholly or partly explain the clinical signs. Findings indicated that, while the prevalence of vertebral venous system abnormalities was low in this sample of sighthounds, the majority of dogs with these abnormalities had clinical signs that matched the location of the abnormalities. Further prospective research is needed to investigate potential underlying aetiologies for vertebral venous system abnormalities in dogs and clarify their clinical significance.
Collapse
Affiliation(s)
- John C Vernon
- School of Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, G61 1QH, UK
| | - Alexane Durand
- School of Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, G61 1QH, UK
| | - Julien Guevar
- School of Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, G61 1QH, UK
| | - Roberto José-López
- School of Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, G61 1QH, UK
| | - Gawain Hammond
- School of Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, G61 1QH, UK
| | - Catherine Stalin
- School of Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, G61 1QH, UK
| | - Rodrigo Gutierrez-Quintana
- School of Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, G61 1QH, UK
| |
Collapse
|
26
|
Rhue KE, Taylor AR, Cole RC, Winter RL. Bilateral Vertebral Venous Sinus Thrombosis Causing Cervical Spinal Cord Compression in a Dog. Front Vet Sci 2017; 4:8. [PMID: 28229071 PMCID: PMC5296347 DOI: 10.3389/fvets.2017.00008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 01/23/2017] [Indexed: 11/13/2022] Open
Abstract
A 10-year-old male neutered mixed breed dog was evaluated for cervical hyperesthesia and tetraparesis. Magnetic resonance imaging of the brain and cervical spinal cord identified an extradural compressive lesion over the body of C2 caused by marked dilation of the vertebral venous sinuses. Following intravenous contrast administration both vertebral sinuses had heterogeneous contrast enhancement consistent with incomplete thrombi formation. An abdominal ultrasound also showed a distal aortic thrombus. A definitive cause for the thrombi formation was not identified, but the patient had several predisposing factors which may have contributed. The patient was treated with a combination of warfarin, clopidogrel, and enoxaparin as well as analgesics. Within 48 h of initiation of warfarin therapy, the tetraparesis and hyperesthesia were markedly improved. Repeat abdominal ultrasound 3 weeks after discharge showed reduction in size of aortic thrombus. Neurologic function remained normal for 6 weeks following initiation of treatment. Seventy-four days following initial diagnosis the patient rapidly declined and passed away at home. Necropsy was declined. This is the first report of vertebral venous sinus enlargement leading to spinal cord compression and tetraparesis in a dog. Additionally, warfarin in combination with clopidogrel and enoxaparin appeared to be a safe and effective treatment for the suspected thrombi reported in this case. Vertebral sinus enlargement secondary to thrombi should be considered as a differential diagnosis in patients presenting with tetraparesis and cervical hyperesthesia.
Collapse
Affiliation(s)
- Kathryn E Rhue
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University , Auburn, AL , USA
| | - Amanda R Taylor
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University , Auburn, AL , USA
| | - Robert C Cole
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University , Auburn, AL , USA
| | - Randolph L Winter
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University , Auburn, AL , USA
| |
Collapse
|
27
|
Darrieutort-Laffite C, Desal H, Berthelot JM, Le Goff B. Detection of a lumbar foraminal venous varix by Color Doppler Ultrasound. Joint Bone Spine 2016; 83:451-2. [PMID: 27068620 DOI: 10.1016/j.jbspin.2015.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Accepted: 09/08/2015] [Indexed: 11/28/2022]
Abstract
Ultrasonography is currently widely used in the rheumatology practice. Although mainly performed to study peripheral joint, several articles have underlined its interest to study spinal anatomy. However, its ability to provide diagnostic features is unknown. We studied the case of a 25-year-old woman having low back pain. Three different imaging modalities (Computed Tomography [CT], Magnetic Resonance Imaging [MRI] and Ultrasound) were used to explore it. CT and MRI showed a foraminal dilation of the lombo-ovarian vein at the L3-L4 level with a scalloping of the lateral edge of L3. We were able to detect it with Color Doppler Ultrasound and a malformation of the inferior vena cava was also found. We showed for the first time that Color Doppler Ultrasound can detect venous malformation of the spine. This imaging modality could help us in the diagnosis of atypical lesions of the spine to confirm their vascular origin.
Collapse
Affiliation(s)
| | - Hubert Desal
- Department of Neuroradiology, hôpital Laënnec, Nantes University Hospital, boulevard Jacques-Monod, 44800 Saint-Herblain, France
| | - Jean-Marie Berthelot
- Rheumatology unit, Nantes University Hospital, Hôtel-Dieu, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France
| | - Benoît Le Goff
- Rheumatology unit, Nantes University Hospital, Hôtel-Dieu, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France
| |
Collapse
|
28
|
Epidural venous plexus engorgement: what lies beneath? Case Rep Radiol 2015; 2015:965106. [PMID: 25722912 PMCID: PMC4334425 DOI: 10.1155/2015/965106] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 01/26/2015] [Indexed: 11/18/2022] Open
Abstract
Epidural venous plexus engorgement may occur due to several conditions that prevent the normal venous circulation. Inferior vena cava agenesis is a very rare cause of epidural venous enlargement. We present a case with a very thin inferior vena cava and left iliac vein agenesis who presented with back pain due to epidural vein engorgement and lacked other venous problems such as deep vein thrombosis.
Collapse
|
29
|
Tsimiklis CA, Gragnaniello C, Abou-Hamden A. Venous sinus thrombosis secondary to tuberculous meningitis: a novel cause of trigeminal neuralgia. BMJ Case Rep 2014; 2014:bcr2014207238. [PMID: 25422343 PMCID: PMC4244377 DOI: 10.1136/bcr-2014-207238] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2014] [Indexed: 11/03/2022] Open
Abstract
A 33-year-old Vietnamese man with a history of superior sagittal sinus thrombosis secondary to tuberculous meningitis presented with severe recurrent trigeminal neuralgia. A complex compensatory cerebral venous drainage system developed, and a varix, in direct contact with the root entry zone of the trigeminal nerve, was the trigger for his pain. The patient's symptoms are presently controlled with a combination of medications for neuropathic pain, however he continues to experience frequent severe exacerbations and may very well require more invasive means to manage his condition in future.
Collapse
Affiliation(s)
| | - Cristian Gragnaniello
- Department of Neurosurgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Amal Abou-Hamden
- Department of Neurosurgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| |
Collapse
|
30
|
Lamparello BM, Erickson CR, Kulthia A, Virparia V, Thet Z. Congenital anomaly of the inferior vena cava and factor V Leiden mutation predisposing to deep vein thrombosis. Vasc Health Risk Manag 2014; 10:609-13. [PMID: 25395858 PMCID: PMC4226457 DOI: 10.2147/vhrm.s66283] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
A previously healthy 21-year-old man presented with back pain, bilateral extremity pain, and right lower extremity weakness, paresthesias, and swelling. Sonographic examination revealed diffuse deep vein thrombosis (DVT) in the femoral and popliteal venous system. CT imaging revealed hypoplasia of the hepatic inferior vena cava (IVC) segment with formation of multiple varices and collateral veins around the kidneys. Hematologic workup also discovered a factor V Leiden mutation, further predisposing the patient to DVT. The rare, often overlooked occurrence of attenuated IVC, especially in the setting of hypercoagulable state, can predispose patients to significant thrombosis.
Collapse
Affiliation(s)
| | | | - Arun Kulthia
- Department of Medicine, Coney Island Hospital, Brooklyn, NY, USA
| | - Vasudev Virparia
- Department of Medicine, Coney Island Hospital, Brooklyn, NY, USA
| | - Zeyar Thet
- Department of Medicine, Coney Island Hospital, Brooklyn, NY, USA
| |
Collapse
|
31
|
Infrahepatic Inferior Vena Cava Agenesis with Bilateral Renal Vein Thrombosis. Ann Vasc Surg 2013; 27:973.e19-23. [DOI: 10.1016/j.avsg.2012.10.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Revised: 10/11/2012] [Accepted: 10/14/2012] [Indexed: 11/19/2022]
|
32
|
Abstract
Lumbar epidural varices are rare and usually mimick lumbar disc herniations. Back pain and radiculopathy are the main symptoms of lumbar epidural varices. Perineural cysts are radiologically different lesions and should not be confused with epidural varix. A 36-year-old male patient presented to us with right leg pain. The magnetic resonance imaging revealed a cystic lesion at S1 level that was compressing the right root, and was interpreted as a perineural cyst. The patient underwent surgery via right L5 and S1 hemilaminectomy, and the lesion was coagulated and removed. The histopathological diagnosis was epidural varix. The patient was clinically improved and the follow-up magnetic resonance imaging showed the absence of the lesion. Lumbar epidural varix should be kept in mind in the differential diagnosis of the cystic lesions which compress the spinal roots.
Collapse
|
33
|
Ganzarain Valiente L, Quintana Rivera A, Ávila Puerta C, Ysa Figueras A, Rodríguez Bustabad M, Fonseca Legrand J. Agenesia de la vena cava inferior como causa de trombosis venosa iliacofemoral bilateral en pacientes jóvenes. ANGIOLOGIA 2013. [DOI: 10.1016/j.angio.2012.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
34
|
Yugueros X, Alvarez B, Fernández E, Boqué M, Matas M. Compressive Symptoms Due to Thrombosed or Hypertrophic Collateral Circulation in Infrarenal Inferior Vena Cava Agenesis. Ann Vasc Surg 2013; 27:238.e9-238.e13. [DOI: 10.1016/j.avsg.2012.06.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2010] [Revised: 03/01/2012] [Accepted: 03/01/2011] [Indexed: 11/25/2022]
|
35
|
Dabasia H, Rahim N, Marshall R. Neurogenic claudication without spinal stenosis arising as a result of lumbar epidural varices. ACTA ACUST UNITED AC 2012; 94:1292-4. [DOI: 10.1302/0301-620x.94b9.29322] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Neurogenic claudication is most frequently observed in patients with degenerative lumbar spinal stenosis. We describe a patient with lumbar epidural varices secondary to obstruction of the inferior vena cava by pathological lymph nodes presenting with this syndrome. Following a diagnosis of follicular lymphoma, successful chemotherapy led to the resolution of the varices and the symptoms of neurogenic claudication. The lumbar epidural venous plexus may have an important role in the pathogenesis of spinal stenosis. Although rare, epidural venous engorgement can induce neurogenic claudication without spinal stenosis. Further investigations should be directed at identifying an underlying cause.
Collapse
Affiliation(s)
- H. Dabasia
- Southampton General Hospital, Department
of Trauma and Orthopaedics, Tremona Road, Southampton, Hampshire
SO16 6YD, UK
| | - N. Rahim
- Royal Berkshire Hospital, Department
of Radiology, Reading RG1 5AN, UK
| | - R. Marshall
- Royal Berkshire Hospital, Department
of Trauma and Orthopaedics, Reading RG1 5AN, UK
| |
Collapse
|
36
|
Ghiassi M, Ghiassi M, Kahn E, Tomycz L, Ayad M, Aaronson O. Cauda equina syndrome secondary to an absent inferior vena cava managed with surgical decompression. J Neurosurg Spine 2011; 16:201-5. [PMID: 22117140 DOI: 10.3171/2011.10.spine1121] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The authors report on the case of a 24-year-old man who presented with back pain and radiculopathy due to epidural venous engorgement in the setting of a congenitally absent inferior vena cava. Despite initial improvement after steroid administration, the patient's health ultimately declined over a period of weeks, and signs and symptoms of cauda equina syndrome manifested. Lumbar decompression was performed and involved coagulation and resection of the compressive epidural veins. No complications occurred, and the patient made a full neurological recovery.
Collapse
Affiliation(s)
- Mayshan Ghiassi
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee 37232-2380, USA
| | | | | | | | | | | |
Collapse
|
37
|
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]
|
38
|
Endres S. Epidural varicosis as a possible cause of radicular pain: a case report. J Med Case Rep 2011; 5:537. [PMID: 22044722 PMCID: PMC3213218 DOI: 10.1186/1752-1947-5-537] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Accepted: 11/01/2011] [Indexed: 11/16/2022] Open
Abstract
Introduction The incidence rate of epidural varicosis has declined by 0.07% to 1.2% since the introduction of computed tomography and magnetic resonance imaging. Despite the use of these modern imaging methods it can still be difficult to distinguish the diagnosis of epidural varicosis from other causes, such as nucleus pulposus prolapse. Case presentation We present the case of a 48-year-old Caucasian woman who had been experiencing sciatic pain for seven years. A physical examination showed nerve root pain at L5 on the right side, with positive signs of neurotension. During an elective hysterectomy due to endometriosis, unusually pronounced varicosis in her lesser pelvis was seen that had not previously been detected. Postoperatively, our patient developed a symptomatic pulmonary embolism. Findings from magnetic resonance tomography of her lumbar spine, in conjunction with our patient's history, were considered by the radiologist to be indicative of epidural varicosis. No further pathological abnormalities that could have been the cause of the nerve root pain were found. Conclusions In cases of epidural varicosis with irritation of neural structures as a result of inferior vena cava hypoplasia, surgical treatment leads to unsatisfactory results. Significantly better results can be achieved by resolving the cause of the vena cava pathology. In cases of hypoplasia or aplasia of the inferior vena cava this is not always possible; consequently, as in the case of our patient, only a symptomatic therapy in combination with an anticoagulant and compression therapy can be performed.
Collapse
Affiliation(s)
- Stefan Endres
- Orthopädie und Unfallchirurgie Elisabeth-Klinik Bigge/Olsberg, Heinrich-Sommer-Strasse 4, 59939 Olsberg, Germany.
| |
Collapse
|
39
|
Kogias E, Kircher A, Deininger MH, Psarras N, Keck T, Schäfer AO, Hubbe U. A very rare cause of low-back pain and sciatica: deep vein thrombosis due to absence of the inferior vena cava mimicking the clinical and radiological signs of lumbar disc herniation. J Neurosurg Spine 2011; 15:164-7. [PMID: 21529127 DOI: 10.3171/2011.4.spine10636] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The authors report a very rare cause of low-back pain and sciatica in a patient with iliac vein thrombosis attributed to absence of the infrarenal segment of the inferior vena cava (IVC) with massively dilated venous collaterals draining via a paraspinal plexus into the azygous system. This 21-year-old man presented with acute low-back pain radiating to the left ventral thigh. The initial CT scan revealed an intraspinal lesion that mimicked lumbar disc herniation. Further clarification revealed an iliac vein thrombosis, which was triggered by the absence of the infrarenal segment of the IVC, a very rare vascular anomaly. Collateral venous return was developed and led to lumbar varicosities and epidural vein engorgements. Laboratory examinations revealed factor V mutation as a predisposing factor for thrombosis. The patient's symptoms were relieved with anticoagulation and antiinflammatory therapy. Absence of the infrarenal IVC associated with iliac vein thrombosis should be regarded as a very rare cause of radicular and low-back pain, and this condition can mimic the clinical and radiological signs of lumbar disc herniation. Sciatica might be the first clinical manifestation of this rare venous anomaly.
Collapse
Affiliation(s)
- Evangelos Kogias
- Department of Neurosurgery, University Medical Center Freiburg, Germany.
| | | | | | | | | | | | | |
Collapse
|
40
|
Hoogland P, Vorster W, Groen R, Kotzé S. Possible thermoregulatory functions of the internal vertebral venous plexus in man and various other mammals: Evidence from comparative anatomical studies. Clin Anat 2011; 25:452-60. [DOI: 10.1002/ca.21274] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Revised: 07/18/2011] [Accepted: 08/05/2011] [Indexed: 01/30/2023]
|
41
|
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.
Collapse
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
| |
Collapse
|
42
|
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.
Collapse
|
43
|
Intradural lumbar varix resembling a tumor: case report of a magnetic resonance imaging-based diagnosis. Spine (Phila Pa 1976) 2010; 35:E864-6. [PMID: 20628334 DOI: 10.1097/brs.0b013e3181d6debb] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Review the presentation and diagnosis of a lumbar intradural varix. OBJECTIVE To report an innovative magnetic resonance imaging (MRI) technique that enabled radiographic diagnosis in a rare case of symptomatic lumbar intradural varix. SUMMARY OF BACKGROUND DATA Lumbar variceal veins rarely occur intradurally, and may radiographically mimic nerve-sheath tumors. These lesions are typically diagnosed at surgery performed due to suspicion of tumor. METHODS A 55-year-old man presented with radicular lower back pain and normal neurologic examination. MRI revealed an ellipsoid intradural enhancing mass at the L2 level. The patient refused to undergo the surgical procedure that was recommended. Over 2-year follow-up, symptoms resolved together with weight reduction. Repeat MRI revealed an unchanged lumbar lesion in addition to engorged epidural and intradural veins, thought to be related to outflow obstruction secondary to past right nephrectomy and obliterated inferior vena cava. Breath-holding and Valsalva maneuvers during MRI caused a change in the shape of the intradural lesion. RESULTS The patient's refusal to undergo surgery led to noninvasive assessment of his lumbar spinal pathology. Diagnosis of nonthrombosed intradural varix was established on MRI-based detection of a change in the shape of the lesion following breath-hold and Valsalva maneuvers. CONCLUSION We diagnosed a nonthrombosed intradural varix by demonstrating a change in the lesion's shape on MRI, following breath-hold and Valsalva maneuvers. This is the first report of nonpathologic, purely radiologic diagnosis of such a lesion. This is a relatively simple, noninvasive method of evaluating these patients.
Collapse
|
44
|
Gonzalo Villanueva B, Herranz Pinilla C, Florit López S, Hospedales Salomó J, Giménez Gaibar A. Dolor lumbar y edema bilateral de extremidades inferiores en varón joven. ANGIOLOGIA 2010. [DOI: 10.1016/s0003-3170(10)70038-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|