Extensive lower limb, pelvic and inferior vena cava thrombosis

Case contributed by Foroogh Jafari Mousavi
Diagnosis almost certain


IV drug user with raised inflammatory markers, entirely swollen right leg, suprapubic and lumbar pain. ? extensive DVT or psoas abscess.

Patient Data

Age: 35 years
Gender: Female

No contrast is seen in the IVC below the level of renal veins. Lack of contrast is also seen in the common iliac, left internal and external iliac, and left femoral veins.These venous structures are expanded. The findings are most in keeping with venous thrombosis. 

There is soft tissue stranding around the right femoral vascular bundle, suggestive of inflammatory changes representing thrombophlebitis. 

A collection of dilated tubular structures with hypodense center are seen in the right side of pelvis that displace bladder to left. These are most likely to represent thrombosed pelvic veins; the differential includes pelvic collections.

MRI study was performed for investigation of back pain which showed increased T1 and T2 signal in infra-renal IVC and common iliac veins in keeping with thrombosis.  

Case Discussion

CT guided aspiration of dilated pelvic structures were performed which returned dark blood confirming the vascular nature of these structures. 

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