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Rajesh R, Gupta M, Kaur N, Lehl SS, Tahlan A, Kaur D. Prevalence of vascular thrombosis in patients with liver abscess. Trop Doct 2024; 54:23-26. [PMID: 37774768 DOI: 10.1177/00494755231204920] [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] [Indexed: 10/01/2023]
Abstract
Thrombotic complications in liver abscess are less commonly identified in the literature. In this prospective observational study, vascular thrombosis was detected in 21.9% cases. However, there was no significant difference in outcome with or without vascular thrombosis, properly treated.
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Affiliation(s)
- Rayidi Rajesh
- Postgraduate Student, Department of General Medicine, Government Medical College and Hospital, Chandigarh, India
| | - Monica Gupta
- Professor, Department of General Medicine, Government Medical College and Hospital, Chandigarh, India
| | - Narinder Kaur
- Professor, Department of Radiodiagnosis, Government Medical College and Hospital, Chandigarh, India
| | - Sarabmeet Singh Lehl
- Professor, Department of General Medicine, Government Medical College and Hospital, Chandigarh, India
| | - Anita Tahlan
- Professor, Department of Pathology, Government Medical College and Hospital, Chandigarh, India
| | - Daljinderjit Kaur
- Postgraduate Resident, Department of General Medicine, Government Medical College and Hospital, Chandigarh, India
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2
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O'Halloran L, O'Halloran A, Murphy S, Morris S. Lumbar spinal intraosseous schwannoma: a non-operative approach. BMJ Case Rep 2022; 15:e249287. [PMID: 36593632 PMCID: PMC9743289 DOI: 10.1136/bcr-2022-249287] [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] [Indexed: 12/13/2022] Open
Abstract
Intraosseous schwannomas are benign tumours composed of nerve sheath cells, most commonly affecting the mandible and sacrum. Such intraosseous schwannomas in the vertebra can result in spinal instability causing deformity, pain and even neurological compression. Vertebral involvement in the lumbar spine is extremely rare. A case of a schwannoma of the lumbar spine at the level of L3/L4 is presented. It resulted in progressive lower back pain and right lower limb radiculopathy. The clinical findings, radiological reports and histological diagnosis of this case, along with a review of the literature, are presented. The rationale for non-surgical management of this rare benign tumour is also explored.
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Affiliation(s)
- Louis O'Halloran
- Department of Orthopaedics and Spinal Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Amanda O'Halloran
- Department of Orthopaedics and Spinal Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | | | - Seamus Morris
- Department of Orthopaedics and Spinal Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
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3
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Yeaman C, Peruri A, Rodriguez-Carpio T, Sharma A, Ramcharitar R, Krupski T, Khaja M. Inferior Vena Cava Thrombus Secondary to Ureteropelvic Junction Obstruction with Severe Hydronephrosis. Curr Med Imaging 2021; 18:353-356. [PMID: 34165409 DOI: 10.2174/1573405617666210623152051] [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: 01/29/2021] [Revised: 04/05/2021] [Accepted: 04/08/2021] [Indexed: 11/22/2022]
Abstract
Benign external compression of the inferior vena cava (IVC) with distal thrombus formation is seldomly described in the medical literature. We report a case of external IVC compression by a dilated right renal pelvis and hydronephrotic kidney secondary to longstanding ureteropelvic junction (UPJ) obstruction found in a 68-year-old male. Management included therapeutic anticoagulation, IVC filter placement, attempted thrombectomy by interventional radiology and interval repeat imaging. This patient demonstrated complete resolution of the caval thrombus on repeat imaging 2 months following discharge. This case highlights the importance of interdisciplinary team coordination, a crucial component of this patient's management and eventual treatment plan. It is reasonable to manage patients with IVC thrombus with anticoagulation alone. In the modern era, angiointerventional techniques provide for minimally invasive approaches to the management of vascular disorders and minimize morbidity.
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Affiliation(s)
- Clinton Yeaman
- Department of Urology, University of Virginia, United States
| | - Adithya Peruri
- Vascular medicine, Department of Cardiology, University of Virginia, United States
| | | | - Aditya Sharma
- Vascular medicine, Department of Cardiology, University of Virginia, United States
| | - Randy Ramcharitar
- Vascular medicine, Department of Cardiology, University of Virginia, United States
| | - Tracey Krupski
- Department of Urology, University of Virginia, United States
| | - Minhaj Khaja
- Department of Radiology, University of Virginia, United States
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4
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Yin X, Blumenfeld JD, Riyahi S, Luo X, Rennert H, Barash I, Prince MR. Prevalence of Inferior Vena Cava Compression in ADPKD. Kidney Int Rep 2020; 6:168-178. [PMID: 33426396 PMCID: PMC7783582 DOI: 10.1016/j.ekir.2020.10.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 09/17/2020] [Accepted: 10/20/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction Kidney and liver cysts in autosomal dominant polycystic kidney disease (ADPKD) can compress the inferior vena cava (IVC), but IVC compression prevalence and its risk factors are unknown. Methods Patients who have ADPKD (n = 216) with abdominal magnetic resonance imaging (MRI) studies and age-/sex-matched controls (n = 216) were evaluated for IVC compression as well as azygous vein diameter (a marker of collateral blood flow) and IVC aspect ratio (left-to-right dimension divided by anterior-to-posterior dimension with a value of 1 corresponding to a circular (high pressure) IVC caudal to compression. Results Severe IVC compression (≥70%) was observed in 33 (15%) ADPKD subjects and mild compression (≥50% to <70%) was observed in 33 (15%) subjects; whereas controls had no IVC compression (P < 0.001). Severe IVC compression was associated with larger azygous vein (4.0 ± 1.3 mm versus 2.3 ± 0.8 mm without IVC compression; P < 0.001) and a more circular IVC cross-section upstream (mean IVC aspect ratio: 1.16 ± 0.27 vs. 1.69 ± 0.67, P < 0.001), suggesting higher pressure upstream from the compression. IVC compression was associated with older age, lower estimated glomerular filtration rate (eGFR), greater height-adjusted total kidney volumes, greater height-adjusted liver volume (ht-LV), and greater liver and renal cyst fractions (P < 0.001). No subject younger than 30 years had IVC compression, but ADPKD subjects ≥40 years old had 12-fold higher risk of IVC compression (95% confidence interval [CI]: 4.2–42.4), with highest predicted probability for Mayo Clinic classes 1D (59%; 95% CI: 39%–76%) and 1E (74%; 95% CI: 49%–90%) after adjustment (P < 0.001). Women with ht-LV ≥ 2000 ml/m had 83% (95% CI: 59%–95%) prevalence of IVC compression. Complications of IVC compression included deep vein thrombosis (DVT) and symptomatic hypotension. Conclusions IVC compression is common in ADPKD patients >40 years old, with Mayo Clinic class 1D/E, and in females with ht-LV > 2000 ml/m.
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Affiliation(s)
- Xiaorui Yin
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA.,Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jon D Blumenfeld
- The Rogosin Institute, New York, New York, USA.,Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Sadjad Riyahi
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA
| | - Xianfu Luo
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA
| | - Hanna Rennert
- Department of Pathology, Weill Cornell Medicine, New York, New York, USA
| | - Irina Barash
- The Rogosin Institute, New York, New York, USA.,Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Martin R Prince
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA.,Department of Radiology, Columbia College of Physicians and Surgeons, New York, New York, USA
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Pazur V, Dakovic Bacalja I, Cvjetko I, Borovecki A. Abdominal aortic and iliac aneurysm presented as lower limb deep vein thrombosis: case report. Acta Chir Belg 2020; 120:271-273. [PMID: 30422747 DOI: 10.1080/00015458.2018.1538282] [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] [Indexed: 10/27/2022]
Abstract
Introduction: We report a rare case of a symptomatic abdominal aneurysm presented as a lower limb deep vein thrombosis (DVT).Case presentation: A 63-year old male presented to our hospital with a recent progressive onset of the right lower limb swelling and pain. The patient had a history of a previous cardiovascular disease. A Duplex ultrasound was performed, which confirmed a right lower limb DVT extending to the right iliac vein. The patient had a pulsatile abdominal mass. Computed tomography scan of the abdomen showed an abdominal aortic and a right iliac artery aneurysm compressing the thrombosed inferior caval and the right iliac vein. The patient was treated with low molecular weight heparin. After resolution of the DVT on day 3 of hospitalization, a surgery on the abdominal and iliac artery aneurysm was performed. The aneurysm was resected and an aortobifemoral bypass was placed using a Dacron prosthesis. The patient remained to be asymptomatic for 6 months after the surgery. Follow up computed tomography demonstrated a fully patent inferior caval and iliac vein and the absence of the aneurysmal disease.Conclusion: Although rare, our case confirms that the DVT should be considered as a possible symptom of an abdominal aneurysm in selected patients.
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Affiliation(s)
- Vedran Pazur
- Vascular surgery, University hospital Merkur, Zagreb, Croatia
| | | | | | - Ana Borovecki
- Department of Pathology, School of Medicine, Univerisity Zagreb, Zurich, Switzerland
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Ko MK, Kim T, Lee WH, Park SH, Choi JH, Shin M, Heo NY. [Deep Vein Thrombosis Due to Compression of Huge Hepatic Cyst Successfully Treated by Inferior Vena Cava Filter and Cyst Drainage]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2018; 72:146-149. [PMID: 30270597 DOI: 10.4166/kjg.2018.72.3.146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
An 88-year-old woman complained of right quadrant abdominal pain and severe edema in both legs. She had a history of pulmonary embolism one month ago. Abdomen CT showed a huge hepatic cyst compressing the intrahepatic portion of the inferior vena cava (IVC). The venogram CT showed multifocal thrombosis in the iliocaval and both lower extremity veins. Percutaneous hepatic cyst drainage was carried out. Fluid analysis presented leukocytosis, which suggested an infected hepatic cyst. To prevent secondary pulmonary thromboembolism, an IVC filter was inserted before catheter drainage for the hepatic cyst. One week later, abdominal pain was relieved. Then, sclerotherapy for the remnant hepatic cyst was performed by ethanol. Follow-up CT showed an increased amount of thrombosis in the iliocaval and left calf vein, but the IVC filter prevented another thromboembolic event successfully. The patient started dabigatran, a new oral anticoagulant, and compression stockings were applied to both legs. After one month, no visible thrombosis in the pelvis or either extremity was detected in abdominal CT. This case suggests that a huge hepatic cyst, especially with infection, should be considered as a possible cause of deep vein thrombosis if no other risk factors for thromboembolism exist.
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Affiliation(s)
- Myung Kwan Ko
- Departments of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Taehong Kim
- Departments of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Won Hyuk Lee
- Departments of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Seung Ha Park
- Departments of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Joon Hyuk Choi
- Departments of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Minwoo Shin
- Departments of Radiology, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Nae Yun Heo
- Departments of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
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A case of inferior vena cava thrombosis caused by compression due to growing giant liver cyst. Clin J Gastroenterol 2018; 12:71-75. [PMID: 30039460 DOI: 10.1007/s12328-018-0885-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 07/09/2018] [Indexed: 10/28/2022]
Abstract
We report a case of inferior vena cava (IVC) thrombosis caused by compression by a giant liver cyst. A 68-year-old man with a 1-day history of abdominal pain was referred to another hospital. Ultrasonography (US) and enhanced computed tomography (CT) showed a multilobular cyst on the right liver lobe that had increased to 300 mm in diameter from 90 mm 18 months earlier. Thrombosis was detected in the IVC, which was compressed by the cyst. Percutaneous transhepatic cyst drainage achieved no significant change in size. Cytological analysis from the percutaneous drainage tube fluid showed no evidence of malignancy. He was referred to our hospital for further assessment and treatment. Enhanced US using perfluorobutane, CT, and magnetic resonance imaging showed no tumorous lesions in the cyst. Thus, we diagnosed it as a multilobular cyst with no evidence of malignancy. A 3-week course of heparin resulted in the successful resolution of the thrombosis. Cystectomy was subsequently performed and pathological examination showed a multifocal cyst consisting of central suppurative inflammatory exudation and hemorrhagic material, with no malignancy. This case demonstrates that giant, expanding, non-tumorous cysts can cause IVC thrombosis. Careful treatment using heparin successfully resolved the thrombosis and allowed successful cystectomy.
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Zhang C, Ma YF, Yang YL. Jaundice caused by protrusion of a hepatic cyst into common bile duct that was resolved by choledochoscopic needle-knife electrotomy: a case report. BMC Gastroenterol 2018; 18:90. [PMID: 29921238 PMCID: PMC6009036 DOI: 10.1186/s12876-018-0815-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 06/05/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUD Hepatic cysts are the most frequent, innocuous, space-occupying lesions of the liver. The majority of solitary liver cysts are nonsymptomatic. When liver cysts reach a large size, there are some complications, including infection, rupture, spontaneous hemorrhage, obstructive jaundice, and neoplastic degeneration. Percutaneous aspiration, fenestration, hepatic resection, and liver transplantation have been proposed for symptomatic patients. CASE PRESENTATION In this case report, we describe a 41-year-old woman who presented with persistent liver dysfunction, indolent xanthochromia, and skin itching for 3 months. After a series of tests, she has a 5.0 × 5.3 cm hepatic cyst with many separations in the left medial liver lobe. The obstructive jaundice was caused by a large pedunculated lump protruding into the common bile duct from the left hepatic duct. She was treated with laparotomy and this lump was completely removed from the root by choledochoscopic needle-knife electrotomy with a good clinical response. Postoperative pathology of the lump suggested a hepatic cyst wall without heterocysts or tumor cells. CONCLUSION Hepatic cyst wall protruding into the common bile duct can form capsular lump and result in indolent jaundice. Choledochoscopic high-frequency needle-knife electrotomy could be considered as a simple, safe and effective complementary approach for benign mass on the bile duct wall.
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Affiliation(s)
- Cheng Zhang
- Department of Biliary Minimally Invasive Surgery, Affiliated Zhongshan Hospital of Dalian University, Dalian, 116001, Liaoning Province, China
| | - Yue-Feng Ma
- Department of Biliary Minimally Invasive Surgery, Affiliated Zhongshan Hospital of Dalian University, Dalian, 116001, Liaoning Province, China
| | - Yu-Long Yang
- Cholelithiasis Center, East Hospital of Tongji University, 150 Jimo Road, Pudong, Shanghai, 200120, China.
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Kallstrom E, Rampoldi M. Differential Diagnosis of an Inferior Vena Cava Thrombosis/Hepatic Cyst Using an Abdominal Sonogram, Echocardiogram, Venography, and Computed Tomography Angiogram. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2017. [DOI: 10.1177/8756479317696826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The role of cardiac sonographers, as health care professionals, comprises facilitating a cardiologist’s diagnosis of valvular lesions, coronary artery disease, and congenital defects and assessing right-side pulmonary complications and so on. Occasionally, communication of differential diagnoses across several modalities, specialties, and healthcare providers is compulsory, in order to accurately confirm or deny an appropriate diagnosis for patients with unique presentations. This case study highlights the vital role of abdominal sonography, echocardiography, venography, and computed tomography in the diagnosis of a hepatic cyst. In addition, it demonstrates the appropriate measures that cardiac sonographers can take to fully investigate these lesions, especially when they are presumed to be a thrombosed inferior vena cava.
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Garge SS, Keshava SN. Intramural inferior vena cava occlusion: The minaret sign. THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2016. [DOI: 10.4103/1110-7782.200970] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Syal G, Klair JS, Aduli F. Leg Swelling and Mildly Deranged Liver Tests: An Unusual Presentation of a Usual Diagnosis. Multiple Simple Liver Cysts. Gastroenterology 2015; 149:e10-1. [PMID: 26123555 DOI: 10.1053/j.gastro.2014.12.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 11/27/2014] [Accepted: 12/29/2014] [Indexed: 12/02/2022]
Affiliation(s)
- Gaurav Syal
- Division of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Jagpal S Klair
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Farshad Aduli
- Division of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
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Kodama K, Takase Y, Motoi I, Seki K, Tatsu H, Terasaki Y. Inferior vena cava thrombosis associated with a distended ileal neobladder. Intern Med 2015; 54:979-81. [PMID: 25876585 DOI: 10.2169/internalmedicine.54.2606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Venous stasis is generally accepted to be a predisposing factor for venous thrombosis. However, benign causes of inferior vena cava (IVC) obstruction with associated thrombus formation have not been well described. We herein present a case of IVC compression caused by a distended ileal neobladder measuring 2,000 mL in capacity that led to IVC thrombosis. Following transurethral drainage for six weeks and anticoagulation therapy with warfarin for six months, the thrombus completely disappeared. The patient was considered to have a hypercoagulable state resulting from an acute urinary tract infection, a condition that may be associated with an increased risk of thrombosis.
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Kraft C, Schuettfort G, Weil Y, Tirneci V, Kasper A, Haberichter B, Schwonberg J, Schindewolf M, Lindhoff-Last E, Linnemann B. Thrombosis of the inferior vena cava and malignant disease. Thromb Res 2014; 134:668-73. [PMID: 25081831 DOI: 10.1016/j.thromres.2014.07.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Revised: 07/07/2014] [Accepted: 07/10/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND Inferior vena cava thrombosis (IVCT) is a rare event, and studies detailing its underlying aetiologies are scarce. METHODS One hundred and forty-one IVCT patients (57% females, median age 47 years) were analysed with a focus on malignancy-related thrombosis and compared with 141 age- and sex-matched control patients with isolated lower-extremity deep vein thrombosis. RESULTS Malignancies were more prevalent among IVCT patients compared with the control group (39% vs. 7.8%; P<0.001). Malignancy-related IVCT more frequently involved the suprarenal and hepatic segments of the IVC and extended more often to the right atrium than IVCT did in non-cancer patients. Among IVCT patients with malignancies, renal cell carcinoma (38%) and other malignancies of the genitourinary tract (25%) were the most common tumours. Analysis of the underlying pathological mechanisms of malignancy-related thrombosis identified external compression of the IVC by tumour masses in 9 cases (16%), and progression of malignancy into the IVC (so-called "tumour thrombosis") in 24 cases (44%). The remaining 22 cases (40%) were attributed to malignancy-related hypercoagulability and the presence of additional venous thromboembolism risk factors, such as previous surgery, immobilisation, or chemotherapy. CONCLUSIONS Malignancies substantially contribute to the risk of thrombosis involving the IVC. Tumour invasion, especially in cases of renal cell cancer and malignancy-related hypercoagulability are major triggering factors for thrombogenesis.
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Affiliation(s)
- Christiane Kraft
- Division of Vascular Medicine, Department of Internal Medicine, Goethe University Hospital, Frankfurt/Main, Germany
| | - Gundolf Schuettfort
- Division of Vascular Medicine, Department of Internal Medicine, Goethe University Hospital, Frankfurt/Main, Germany
| | - Yvonne Weil
- Division of Vascular Medicine, Department of Internal Medicine, Goethe University Hospital, Frankfurt/Main, Germany
| | - Vanessa Tirneci
- Division of Vascular Medicine, Department of Internal Medicine, Goethe University Hospital, Frankfurt/Main, Germany
| | - Alexander Kasper
- Division of Vascular Medicine, Department of Internal Medicine, Goethe University Hospital, Frankfurt/Main, Germany
| | - Barbara Haberichter
- Division of Vascular Medicine, Department of Internal Medicine, Goethe University Hospital, Frankfurt/Main, Germany
| | - Jan Schwonberg
- Division of Vascular Medicine, Department of Internal Medicine, Goethe University Hospital, Frankfurt/Main, Germany
| | - Marc Schindewolf
- Division of Vascular Medicine, Department of Internal Medicine, Goethe University Hospital, Frankfurt/Main, Germany
| | - Edelgard Lindhoff-Last
- Division of Vascular Medicine, Department of Internal Medicine, Goethe University Hospital, Frankfurt/Main, Germany
| | - Birgit Linnemann
- Division of Vascular Medicine, Department of Internal Medicine, Goethe University Hospital, Frankfurt/Main, Germany.
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Musielak MC, Singh R, Hartman E, Bernstein J. Simple hepatic cyst causing inferior vena cava thrombus. Int J Surg Case Rep 2014; 5:339-41. [PMID: 24814982 PMCID: PMC4066569 DOI: 10.1016/j.ijscr.2014.03.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Revised: 03/01/2014] [Accepted: 03/11/2014] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Thrombosis of the inferior vena cava (IVC) is governed by Virchow's triad of stasis of blood flow, endothelial damage and hypercoagulability. Causes may be secondary to malignancy, congenital anomalies or other infrequent events such as external compression. We present a case of external compression of the IVC leading to extensive thrombus burden secondary to a benign hepatic cyst. PRESENTATION OF CASE A 72 year old African American female presented to the emergency department with new onset shortness of breath, right lower extremity weakness and swelling. CT imaging demonstrated multiple hepatic cysts compressing the IVC, leading to extensive clot burden. Treatment with heparin drip was initiated without resolution of her symptoms. Transcatheter mechanical thrombectomy and tPA infusion was performed. After 24 h, swelling and weakness were nearly resolved. The patient was bridged to therapeutic low molecular weight heparin in preparation for surgery. DISCUSSION Management of IVC thrombosis has typically been with a heparin drip and transition to oral anticoagulants. Thrombolysis has been shown to promote complete clot lysis more often than compared to standard anticoagulant therapy. In addition, venous patency was better maintained. CONCLUSION We feel that the added benefit of short term effects of improved venous patency and long term benefits of less post thrombotic syndrome, catheter based tPA administration and mechanical thrombectomy for thrombus offers an adjuvant treatment in the setting of large clot burden refractory to standard treatment.
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Affiliation(s)
| | - Ranjodh Singh
- The Jewish Hospital, 4777 East Galbraith Road, Cincinnati, OH 45236, United States
| | - Elizabeth Hartman
- The Jewish Hospital, 4777 East Galbraith Road, Cincinnati, OH 45236, United States
| | - Joseph Bernstein
- The Jewish Hospital, 4777 East Galbraith Road, Cincinnati, OH 45236, United States
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Abdominal aortic aneurysm with inferior vena cava compression in association with deep venous thrombosis. Am J Med Sci 2014; 346:521-2. [PMID: 24263082 DOI: 10.1097/maj.0b013e3182a55a96] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Deep venous thrombosis (DVT) of the lower extremity may be caused by external compression of the inferior vena cava (IVC) by a neighboring mass. A 55-year-old male presented with 8 months of intermittent left lower extremity swelling and signs of chronic venous stasis. Duplex ultrasound showed extensive DVT in the left leg. Subsequent imaging revealed a 4.2 cm infrarenal abdominal aortic aneurysm (AAA) compressing the IVC. In cases of chronic, unilateral DVT, work-up should include imaging for an anatomic cause. AAA is a rare cause of IVC compression with DVT, and is most commonly related to inflammatory AAAs. Previously reported cases of IVC compression by non-inflammatory AAAs have been secondary to large aneurysms (greater than 6 cm). This case illustrates that smaller AAAs lacking hemodynamically significant IVC obstruction may be found in association with DVT.
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Green RE, Rajendran S, Babiker ME, Prins H. Laparoscopic resection of a large hepatic cyst compressing the inferior vena cava. BMJ Case Rep 2013; 2013:bcr-2013-009638. [PMID: 24045757 DOI: 10.1136/bcr-2013-009638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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17
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Saji N, Shimizu H, Nakamoto M, Kimura K, Kita Y. Elderly case of giant liver cyst presenting with inferior vena cava syndrome and decreased activities of daily life. Geriatr Gerontol Int 2013; 13:226-7. [PMID: 23286562 DOI: 10.1111/j.1447-0594.2012.00901.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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18
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Linnemann B, Schmidt H, Schindewolf M, Erbe M, Zgouras D, Grossmann R, Schambeck C, Lindhoff-Last E. Etiology and VTE risk factor distribution in patients with inferior vena cava thrombosis. Thromb Res 2008; 123:72-8. [PMID: 18295303 DOI: 10.1016/j.thromres.2008.01.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2007] [Revised: 11/30/2007] [Accepted: 01/05/2008] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Inferior vena cava (IVC) thrombosis is a rare event and data detailing the underlying etiology are scarce. MATERIALS AND METHODS Therefore, we reviewed all available cases of IVC thrombosis consecutively registered in the MAISTHRO (MAin-ISar-THROmbosis) database and described the prevalence of VTE risk factors and other conditions contributing to IVC thrombosis development. RESULTS 53 patients (35 F, 18 M) with IVC thrombosis aged 12 to 79 years were identified. 40 patients (75.5%) developed thrombosis under the age of 45. Local problems, such as IVC anomalies or external venous compression, contributed to the development of thrombosis in 12 cases (22.6%). Lupus anticoagulants (10.9 vs. 2.3%, p=0.013) and malignoma (17.0 vs. 6.4%, p=0.023) were more prevalent in IVC thrombosis patients compared to 265 age and sex matched controls with isolated lower extremity DVT. No difference was identified with regard to inherited thrombophilia or other known VTE risk factors. Symptomatic pulmonary embolism (PE) occurred in 32.1% of IVC thrombosis patients compared to 15.2% of controls (p=0.005). CONCLUSIONS Local problems such as IVC anomalies and external venous compression, malignancy and the presence of lupus anticoagulants contribute to the risk of IVC thrombosis. The risk of symptomatic pulmonary embolism in the acute setting is high.
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Affiliation(s)
- Birgit Linnemann
- Division of Vascular Medicine, Department of Internal Medicine, Johann Wolfgang Goethe University Hospital, Theodor-Stern-Kai 7, D-60590 Frankfurt/Main, Germany.
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