#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Symmetrical phlebothrombosis of lower extremities resulting from congenital malformation of vena cava inferior


Authors: A. Halčín 1;  E. Kováčová 1;  F. Mikla 1;  A. Reptová 1;  J. Bedeová 2
Authors‘ workplace: I. interná klinika Lekárskej fakulty UK a FNsP Bratislava, pracovisko Staré mesto, Slovenská republika, prednosta doc. MU Dr. Soňa Kiňová, PhD. 1;  I. rádiologická klinika Lekárskej fakulty UK a FNsP Bratislava, pracovisko Staré mesto, Slovenská republika, prednosta prof. MU Dr. Jozef Bilický, PhD. 2
Published in: Vnitř Lék 2009; 55(12): 1189-1192
Category: Editorials

Overview

Agenesis/ atresia of vena cava inferior is a rare congenital anomaly, caused by an aberrance of embryonal venous system development. This is in most cases asymptomatic, because of well developed collateral venous circulation. However, in some cases, it can be manifested with occurence of deep thrombosis in area of pelvis and lower limbs. In this case report, we repon a 21 year old male with painful swelling of both lower limbs. Ultrasonographic examination revealed a bilateral thrombosis in deep venous system of lower limbs and pelvis. Subsequent CT angiography showed atresia of infrarenal segment of vena cava inferior. According to the CT image thrombotic proces affected also collateral venous system, that joined mostly to vena azygos and hemiazygos. Examination of coagulation system didn’t reveal a procuring cause of thrombotic occurrence. We realized a systemic trombolysis with streptokinase during 5 days. Starting from the fifth day we administered a low molecular weight heparin in anticoagulant dose. This treatment showed a good clinical effect. Pacient was discharged with a long‑term oral warfarin therapy in combination with acetylsalicylic acid. In next four months of taking recommended therapy no relapse of thrombotic process nor evolvement of bleeding complication was observed.

Key words:
agenesis –  vena cava inferior –  phlebothrombosis


Sources

1. Bezemer ID, Doggen CJ, Vos HL et al. No association between the common MTHFR 677C‑ T polymorphism and venous thrombosis: results from the MEGA study. Arch Intern Med 2007; 167: 497– 501.

2. Huisman MV, Rosendaal F. Thrombophilia. Curr Opin Hematol 1999; 6: 291– 297.

3. Bass JE, Redwine MD, Kramer LA et al. Spectrum of congenital anomalies of the inferior vena cava: cross‑ sectional imaging findings. Radiographics 2000; 20: 639– 652.

4. Bass JE, Redwine MD, Kramer LA et al. Absence of the inferior vena cava with preservation of the suprarenal segment as revealed by CT and MR venography. AJR Am J Roentgenol 1999; 172: 1610– 1612.

5. Minniti S, Visenti S, Procacci C. Congenital anomalies of the venae cavae: embryological origin, imaging features and report of three new variants. Eur Radiol 2002; 12: 2040– 2055.

6. Kellman GM, Alpern MB, Sandler MA et al. Computed tomography of vena caval anomalies with embryologic correlation. Radiographics 1988; 8: 533– 556.

7. Sakellaris G, Tilemis S, Papakonstantinou O et al. Deep venous thrombosis in a child associated with an abnormal inferior vena cava. Acta Paediatr 2005; 94: 242– 244.

8. Chee YL, Culligan DJ, Watson HG. Inferior vena cava malformation as a risk factor for deep venous thrombosis in the young. Br J Haematol 2001; 114: 878– 880.

9. Yigita H, Yagmurlub B, Yigita N et al. Low Back Pain as the Initial Symptom of Inferior Vena Cava Agenesis. AJNR Am J Neuroradiol 2006; 27: 593– 595.

10. Obernosterer A, Aschauer M, Schnedl Wet al. Anomalies of the inferior vena cava in patients with iliac venous thrombosis. Ann Intern Med 2002; 136: 37– 41.

11. Ruggeri M, Tosetto A, Castaman G et al. Congenital absence of the inferior vena cava: a rare risk factor for idiopathic deep‑ vein thrombosis. Lancet 2001; 357: 441– 441.

12. Dougherty MJ, Calligaro KD, DeLaurentis DA. Congenitally absent inferior vena cava presenting in adulthood with venous stasis and ulceration: a surgical treated case. J Vasc Surg 1996; 23: 141– 146.

13. Klessen C, Deutsch HJ, Karasch T et al. Thrombosis of the deep leg and pelvic veins in congenital agenesis of the vena cava inferior. Deutsch Med Wochenschr 1999; 124: 523– 526.

Labels
Diabetology Endocrinology Internal medicine

Article was published in

Internal Medicine

Issue 12

2009 Issue 12

Most read in this issue
Topics Journals
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account

#ADS_BOTTOM_SCRIPTS#