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Solano A, Pizano A, Figueroa V, Klein A, Babb J, Prakash V, Chamseddin K, Gonzalez-Guardiola G, Kirkwood ML, Siah MC. Extensive iliofemoral and femoropopliteal venous thrombosis in a young patient with iliocaval atresia. J Vasc Surg Cases Innov Tech 2024; 10:101431. [PMID: 38510086 PMCID: PMC10951498 DOI: 10.1016/j.jvscit.2024.101431] [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: 11/09/2023] [Accepted: 01/05/2024] [Indexed: 03/22/2024] Open
Abstract
Inferior vena cava (IVC) atresia is a rare congenital anomaly. Standardized treatment is not well defined due to its uncommon presentation, with this pathology associated with an increased risk of unprovoked lower extremity deep vein thrombosis (DVT). We present a case of a 32-year-old man who was admitted for bilateral lower extremity edema and pain and was found to have bilateral extensive iliofemoral and femoropopliteal DVT, absence of IVC filling, and extensive tortuous collateralization arising from the pelvic veins to the azygos vein. Bilateral mechanical thrombectomy and endovascular iliocaval reconstruction was performed. Three months later, the patient demonstrated widely patent iliocaval stents and the absence of DVT. Endovascular treatment of IVC atresia is feasible and optimizes the reduction of thrombus burden.
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Affiliation(s)
- Antonio Solano
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Alejandro Pizano
- Department of Surgery, Nassau University Medical Center, East Meadow, NY
| | - Valentin Figueroa
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Andrea Klein
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Jacqueline Babb
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Vivek Prakash
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Khalil Chamseddin
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Gerardo Gonzalez-Guardiola
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Melissa L. Kirkwood
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Michael C. Siah
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
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2
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Soodi D, Nwaedozie S, Shah M, Girotra S. Transhepatic approach of patent foramen ovale closure in the setting of congenital inferior vena cava anomaly. Clin Case Rep 2024; 12:e8653. [PMID: 38464577 PMCID: PMC10923700 DOI: 10.1002/ccr3.8653] [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: 12/14/2023] [Revised: 02/22/2024] [Accepted: 03/01/2024] [Indexed: 03/12/2024] Open
Abstract
Patent foramen ovale (PFO) is the most common interatrial septal abnormality. The indications for PFO device closure are still being evaluated, with the most common reason being to prevent cerebrovascular accidents (CVA) caused by paradoxical embolism of deep vein thrombosis (DVT) in the lower extremities. This procedure is usually performed through percutaneous intervention using femoral vein access. Here, we present a case of PFO closure using a transhepatic approach, as femoral vein access was not feasible due to an interrupted inferior vena cava (IVC). The patient had a prominent left-sided IVC, larger than the right-sided IVC, and the left-sided IVC served as the main draining conduit via the hemiazygous system, which then connected to the azygous vein and emptied into the right atrium (RA). Cardiac MRI confirmed these findings, including the continuation of the suprahepatic IVC to the right atrium. With the assistance of interventional radiologist, transhepatic access was achieved, and the PFO was successfully closed. Hemostasis was achieved using coil embolization, and there were no post-procedural complications.
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Affiliation(s)
- Deepa Soodi
- Marshfield Clinic Health SystemMarshfieldWisconsinUSA
| | | | - Milind Shah
- Marshfield Clinic Health SystemMarshfieldWisconsinUSA
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3
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Louagé F, Moradi M, Vanrossomme A. Recurring hematuria revealing absence of infrarenal segment of the inferior vena cava. Radiol Case Rep 2022; 17:4083-4086. [PMID: 36065243 PMCID: PMC9440369 DOI: 10.1016/j.radcr.2022.07.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 07/28/2022] [Accepted: 07/31/2022] [Indexed: 11/18/2022] Open
Abstract
Abnormal development of the inferior vena cava is a relatively rare condition. We report the case of a 47-year-old woman presenting with an absent infrarenal segment of the inferior vena cava revealed by recurring episodes of gross hematuria. This entity probably resulted from perinatal acquired thrombosis rather than from a congenital anomaly and is associated with compensatory dilation of collateral venous pathways. This extremely rare hemorrhagic presentation is presumably caused by rupture of small dilated renal or vesical veins. Ignorance of this atypical presentation can lead to erroneous or delayed diagnoses.
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4
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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.
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Affiliation(s)
| | | | | | - Dimitrios Virvilis
- Correspondence: Dimitrios Virvilis, MD, Stony Brook University Hospital, 101 Nicolls Rd, Stony Brook, NY 11794
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5
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Chemtob RA, Hodges KE, Marc Gillinov A. Anomalous inferior vena cava drainage in a patient undergoing cardiac surgery. J Card Surg 2022; 37:2443-2445. [PMID: 35575405 DOI: 10.1111/jocs.16611] [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: 03/28/2022] [Revised: 05/04/2022] [Accepted: 05/05/2022] [Indexed: 11/30/2022]
Abstract
Congenital anomalies of the inferior vena cava are rare but if unidentified may create a risk for complications during surgery. In cardiac surgery, identifying such anomalies is crucial as they may alter the normal conduct of cardiopulmonary bypass. Herein, we describe a case of a 78-year-old women with an anomalous inferior vena cava draining into the superior vena cava, who was referred for surgical management of severe mitral regurgitation. We describe the clinical implication of the inferior vena cava anomality and the surgical strategies used to obtain adequate surgical exposure and venous drainage for cardiopulmonary bypass in a patient who underwent a mitral and tricuspid annuloplasty, bi-atrial MAZE procedure and a left atrial appendage closure.
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Affiliation(s)
- Raphaelle A Chemtob
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Kevin E Hodges
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Alan Marc Gillinov
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio, USA
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6
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Bønløkke ST, Serifi MA, Mikkelsen TS, Hvas A. Catheter‐directed thrombolysis for massive deep vein thrombosis in an adolescent with severe antithrombin deficiency. Clin Case Rep 2022; 10:e05681. [PMID: 35498359 PMCID: PMC9040422 DOI: 10.1002/ccr3.5681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 03/11/2022] [Accepted: 03/22/2022] [Indexed: 11/08/2022] Open
Affiliation(s)
- Søren Thorgaard Bønløkke
- Department of Clinical Biochemistry Aarhus University Hospital Aarhus Denmark
- Department of Clinical Medicine Aarhus University Aarhus Denmark
| | | | - Torben Stamm Mikkelsen
- Department of Clinical Medicine Aarhus University Aarhus Denmark
- Department of Pediatrics Aarhus University Hospital Aarhus Denmark
| | - Anne‐Mette Hvas
- Department of Clinical Biochemistry Aarhus University Hospital Aarhus Denmark
- Department of Clinical Medicine Aarhus University Aarhus Denmark
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7
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Ledgard C, Clarke J, McGreal GT. Rare congenital abnormality resulting in spontaneous bilateral deep venous thrombosis and pulmonary emboli in a young healthy man. BMJ Case Rep 2022; 15:e246555. [PMID: 35228226 PMCID: PMC8886358 DOI: 10.1136/bcr-2021-246555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2022] [Indexed: 11/04/2022] Open
Abstract
This report describes a unique case of a healthy man in his 30s, who presented with progressive unilateral leg swelling with no common risk factors identified. Two days prior to the swelling he had developed significant abdominal pain following a treadmill exercise session. Ultrasound imaging revealed extensive deep vein thrombosis involving bilateral ileo-femoral venous systems, extending up the inferior vena cava (IVC). Further investigation using a CT venogram revealed the rare congenital anomaly of hypoplasia of the renal IVC. Successful treatment involved 48 hours of an intravenous unfractionated heparin infusion, followed by lifelong anticoagulation.
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Affiliation(s)
- Celina Ledgard
- Department of Vascular Surgery, Mercy University Hospital, Cork, Ireland
| | - James Clarke
- Department of Vascular Surgery, Mercy University Hospital, Cork, Ireland
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8
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Li SJ, Lee J, Hall J, Sutherland TR. The inferior vena cava: anatomical variants and acquired pathologies. Insights Imaging 2021; 12:123. [PMID: 34460015 PMCID: PMC8405820 DOI: 10.1186/s13244-021-01066-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 08/07/2021] [Indexed: 01/05/2023] Open
Abstract
The inferior vena cava (IVC) is the largest vein in the body, draining blood from the abdomen, pelvis and lower extremities. This pictorial review summarises normal anatomy and embryological development of the IVC. In addition, we highlight a wide range of anatomical variants, acquired pathologies and a common pitfall in imaging of the IVC. This information is essential for clinical decision making and to reduce misdiagnosis.
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Affiliation(s)
- Simon J Li
- Medical Imaging Department, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC, 3065, Australia.
| | - Jean Lee
- Medical Imaging Department, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC, 3065, Australia
| | - Jonathan Hall
- Medical Imaging Department, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC, 3065, Australia.,Department of Radiology, Austin Health, Heidelberg, VIC, Australia
| | - Tom R Sutherland
- Medical Imaging Department, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC, 3065, Australia.,Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC, Australia
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9
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Weijmans M, Vermeulen R, Kleijwegt FS, Boiten HJ. An abdominal mass with thrombosis due to inferior vena cava agenesis mimicking lymphoma. Ann Hematol 2021; 100:2871-2872. [PMID: 34337684 PMCID: PMC8325987 DOI: 10.1007/s00277-021-04626-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 07/25/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Maaike Weijmans
- Department of Hematology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Rosa Vermeulen
- Department of Hematology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Fleur S Kleijwegt
- Department of Hematology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Henk-Jan Boiten
- Department of Hematology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands. .,Department of Internal Medicine, Erasmus MC, University Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
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10
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Morris RI, Sobotka PA, Balmforth PK, Stöhr EJ, McDonnell BJ, Spencer D, O'Sullivan GJ, Black SA. Iliocaval Venous Obstruction, Cardiac Preload Reserve and Exercise Limitation. J Cardiovasc Transl Res 2020; 13:531-539. [PMID: 32040765 PMCID: PMC7423854 DOI: 10.1007/s12265-020-09963-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 01/22/2020] [Indexed: 12/16/2022]
Abstract
Cardiac output during exercise increases by as much as fivefold in the untrained man, and by as much as eightfold in the elite athlete. Increasing venous return is a critical but much overlooked component of the physiological response to exercise. Cardiac disorders such as constrictive pericarditis, restrictive cardiomyopathy and pulmonary hypertension are recognised to impair preload and cause exercise limitation; however, the effects of peripheral venous obstruction on cardiac function have not been well described. This manuscript will discuss how obstruction of the iliocaval venous outflow can lead to impairment in exercise tolerance, how such obstructions may be diagnosed, the potential implications of chronic obstructions on sympathetic nervous system activation, and relevance of venous compression syndromes in heart failure with preserved ejection fraction.
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Affiliation(s)
- Rachael I Morris
- School of Cardiovascular Medicine and Sciences, King's College London, London, UK.
| | - Paul A Sobotka
- The Ohio State University, Columbus, OH, USA
- V-Flow Medical Inc., Saint Paul, CA, USA
| | | | - Eric J Stöhr
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Centre, New York City, USA
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Barry J McDonnell
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | | | | | - Stephen A Black
- School of Cardiovascular Medicine and Sciences, King's College London, London, UK
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11
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Tarazi M, Bashir A, Khan K, Kakani N, Murray D, Serracino-Inglott F. A Literature Review and Case Series of DVT Patients with Absent IVC Treated with Thrombolysis. Ann Vasc Surg 2020; 67:521-531. [PMID: 32234401 DOI: 10.1016/j.avsg.2020.03.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 03/19/2020] [Accepted: 03/21/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Congenital absence of the inferior vena cava is related to deep venous thrombosis (DVT) in 5% of cases with no other risk factors. DVT is normally diagnosed by Duplex, whereas computerized tomography or magnetic resonance imaging is required to visualize this absence, and so, it is often missed but ought to be considered in young patients. There are many existing cases in the literature illustrating this link, but these patients were often managed conservatively with anticoagulation. CASE SERIES We report five cases presenting with a DVT who were found to have an absent inferior vena cava after imaging and were treated successfully with thrombolysis and consequently managed with lifelong anticoagulation, between January 2014 and January 2019. CONCLUSIONS Anomalies of the inferior vena cava can cause unprovoked DVT. These anomalies are often incidental findings after CT but could change the management plan in these patients. Treatment can be with anticoagulants only, thrombolysis, thrombectomy, balloon angioplasty or stents, and long-term or lifelong anticoagulation to prevent DVT recurrence.
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Affiliation(s)
- Munir Tarazi
- Department of Vascular Surgery, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK.
| | - Ammani Bashir
- Department of Vascular Surgery, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
| | - Kamran Khan
- Department of Vascular Surgery, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
| | - Nirmal Kakani
- Department of Vascular Interventional Radiology, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
| | - David Murray
- Department of Vascular Surgery, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
| | - Ferdinand Serracino-Inglott
- Department of Vascular Surgery, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
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12
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Tufano A, López-Jiménez L, Bikdeli B, García-Bragado F, Mazzolai L, Amitrano M, Gómez-Cuervo C, Marchena PJ, Madridano O, Monreal M, Di Micco P. Inferior vena cava agenesis in patients with lower limb deep vein thrombosis in the RIETE registry. When and why to suspect. Int J Cardiol 2020; 305:115-119. [DOI: 10.1016/j.ijcard.2020.01.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 12/12/2019] [Accepted: 01/08/2020] [Indexed: 12/12/2022]
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13
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The use of rivaroxaban in deep venous thrombosis associated with vena cava inferior agenesis. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2020; 27:583-585. [PMID: 32082931 DOI: 10.5606/tgkdc.dergisi.2019.17672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Accepted: 04/08/2019] [Indexed: 11/21/2022]
Abstract
Inferior vena cava agenesis is a rare anomaly which may result in deep vein thrombosis. There is no clear scientific evidence for the most effective therapeutic management, optimal duration, or the choice of anticoagulant therapy. Herein, we report an 18-year-old male case with deep vein thrombosis associated with inferior vena cava agenesis who was on rivaroxaban as a lifelong anticoagulation treatment for symptoms of venous stasis and the presence of heterozygotic thrombophilic mutations.
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14
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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.
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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
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15
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Gardner K, Kharasch S, Raja A, Balza R, Bhatia K, Miller ES. Back Pain in a Healthy Teenager. J Emerg Med 2017; 53:907-911. [PMID: 28684061 DOI: 10.1016/j.jemermed.2017.04.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 04/25/2017] [Indexed: 06/07/2023]
Affiliation(s)
- Kelly Gardner
- Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Sigmund Kharasch
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts; Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts
| | - Ali Raja
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts; Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts
| | - Rene Balza
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Department of Radiology, Harvard Medical School, Boston, Massachusetts
| | - Kriti Bhatia
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts; Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Emily S Miller
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts; Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts
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