Presentation
Swelling and edema of left leg - deep vein thrombosis?
Patient Data
Concentrated contrast material in the collecting system and urinary bladder due to a previous CT exam done several hours earlier.
No evidence of deep vein thrombosis.
Absent infrarenal IVC and common iliac veins (CIV); the suprarenal IVC is preserved. The external and internal iliac veins drain into the ascending lumbar veins, which in turn drain into the azygos-hemiazygos system. Collateral drainage of the left kidney. Varicosities in the abdominal wall and lower extremities.
Case Discussion
The infrarenal IVC and common iliac veins were obliterated by thrombosis in very early childhood. Thrombosis along the entire left femoral vein two years ago. B2 glycoprotein 1, IgM antibody > 40 SMU (normal ≤20 SMU).
The CT study shows that in the absence of the above veins, the internal and external iliac veins drain into the ascending lumbar veins, thence into the azygos-hemiazygos system, and that the left kidney is drained by meandering squiggly collateral veins.
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