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Chronic IVC thrombosis with extensive collaterals

Case contributed by Mahmoud Ibrahim Mekhaimar
Diagnosis almost certain

Presentation

Multiple disfiguring abdominal swellings

Patient Data

Age: 30 years
Gender: Male

Post-contrast CT with MPR and 3D reconstructions revealed:

  • markedly reduced caliber of the IVC with irregular outline
  • diffuse extensive dilated vascular collaterals involving the abdominal walls, peritoneal, retroperitoneal and pelvic cavities
  • prominent azygos and hemiazygous veins
  • hypodense right hepatic lobe segment VIII lesion. (incidental finding).
  • no current filling defect in the IVC is seen
  • 3D VR and surface rendering image shows the disfiguring abdominopelvic swelling

Case Discussion

Thrombosis of the inferior vena cava (IVC) is an under-reported finding. Congenital anomalies aside, the commonest cause of IVC thrombosis is an IVC filter in situ. 

Thrombosis of the IVC has the same etiologic risk factors as deep vein thrombosis:

  • hypercoagulable states
  • venous stasis
  • compression by neoplastic lesions, lymph nodes, retroperitoneal masses/fibrosis or hemorrhage
  • foreign bodies: vena cava filter, catheters
  • extension from benign tumors: angiomyolipoma, IVC leiomyoma, adrenal pheochromocytoma
  • traumatic liver injury: very rare 
  • malignant process
  • congenital
    • congenital absence of the infrarenal inferior vena cava occurs as a result of the failure of development of the posterior cardinal and supracardinal veins

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