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Inferior vena cava anomaly: a risk for deep vein thrombosis.

Sitwala PS, Ladia VM, Brahmbhatt PB, Jain V, Bajaj K - N Am J Med Sci (2014)

Bottom Line: A 29-year-old male patient presented with recurrent lower extremity ulcers.Further workup revealed an absent infrahepatic inferior vena cava, prominently dilated azygos and hemiazygos veins with enlarged retroperitoneal collaterals without DVT.Thus per Virchow's triad, other risk factors for hypercoagulability such as physical inactivity, smoking tobacco, oral contraceptive pills should be avoided and when hereditary thrombophilias or other irreversible risk factors are present, lifelong anticoagulation should be considered.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Quillen College of Medicine, East Tennessee State University, Johnson City, USA.

ABSTRACT

Context: Inferior vena cava (IVC) anomalies have a 0.5% incidence rate and could be associated with other congenital abnormalities. In later stage of the disease, trophic ulcers with or without deep vein thrombosis (DVT) is consistent finding.

Case report: A 29-year-old male patient presented with recurrent lower extremity ulcers. Further workup revealed an absent infrahepatic inferior vena cava, prominently dilated azygos and hemiazygos veins with enlarged retroperitoneal collaterals without DVT.

Conclusion: IVC anomaly should be suspected in a young patient presenting with unexplained venous thrombosis and recurrent ulcers of a lower extremity. IVC anomaly would inherently lead to blood flow stasis and endothelial injury. Thus per Virchow's triad, other risk factors for hypercoagulability such as physical inactivity, smoking tobacco, oral contraceptive pills should be avoided and when hereditary thrombophilias or other irreversible risk factors are present, lifelong anticoagulation should be considered.

No MeSH data available.


Related in: MedlinePlus

Compensatory dilated collateral veins
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Figure 2: Compensatory dilated collateral veins

Mentions: A previously healthy 29-year-old white male presented with right lower extremity edema, pain and multiple recurrent pretibial ulcers over a period of one year. He had been treated with two rounds of intravenous and oral antibiotics and also had been following up in a wound care clinic for several months. The patient lost follow-up and his ulcers recurred in 2 months after which he came to the hospital. Physical exam showed severe right leg edema, erythema, stasis dermatitis and 4 ulcers ranging from 0.5-2.5 cm in diameter on the anteromedial shin and above the medial malleolus, with pulses were present in bilateral lower extremity [Figure 1]. Rest of the physical exam along with the left leg was normal. Venous duplex of right lower extremity showed diffuse scarring of popliteal and lesser saphenous vein without any DVT. In order to rule out any IVC compromise a computerized tomography angiography (CTA) of abdomen was performed which showed an absent infrahepatic IVC, prominently dilated azygos and hemiazygos veins with enlarged retroperitoneal collaterals [Figure 2]. Further magnetic resonance angiography of lower extremity and abdomen was performed which revealed absence of infrahepatic IVC with right mid-thigh venous anomaly [Figure 3].


Inferior vena cava anomaly: a risk for deep vein thrombosis.

Sitwala PS, Ladia VM, Brahmbhatt PB, Jain V, Bajaj K - N Am J Med Sci (2014)

Compensatory dilated collateral veins
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4264299&req=5

Figure 2: Compensatory dilated collateral veins
Mentions: A previously healthy 29-year-old white male presented with right lower extremity edema, pain and multiple recurrent pretibial ulcers over a period of one year. He had been treated with two rounds of intravenous and oral antibiotics and also had been following up in a wound care clinic for several months. The patient lost follow-up and his ulcers recurred in 2 months after which he came to the hospital. Physical exam showed severe right leg edema, erythema, stasis dermatitis and 4 ulcers ranging from 0.5-2.5 cm in diameter on the anteromedial shin and above the medial malleolus, with pulses were present in bilateral lower extremity [Figure 1]. Rest of the physical exam along with the left leg was normal. Venous duplex of right lower extremity showed diffuse scarring of popliteal and lesser saphenous vein without any DVT. In order to rule out any IVC compromise a computerized tomography angiography (CTA) of abdomen was performed which showed an absent infrahepatic IVC, prominently dilated azygos and hemiazygos veins with enlarged retroperitoneal collaterals [Figure 2]. Further magnetic resonance angiography of lower extremity and abdomen was performed which revealed absence of infrahepatic IVC with right mid-thigh venous anomaly [Figure 3].

Bottom Line: A 29-year-old male patient presented with recurrent lower extremity ulcers.Further workup revealed an absent infrahepatic inferior vena cava, prominently dilated azygos and hemiazygos veins with enlarged retroperitoneal collaterals without DVT.Thus per Virchow's triad, other risk factors for hypercoagulability such as physical inactivity, smoking tobacco, oral contraceptive pills should be avoided and when hereditary thrombophilias or other irreversible risk factors are present, lifelong anticoagulation should be considered.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Quillen College of Medicine, East Tennessee State University, Johnson City, USA.

ABSTRACT

Context: Inferior vena cava (IVC) anomalies have a 0.5% incidence rate and could be associated with other congenital abnormalities. In later stage of the disease, trophic ulcers with or without deep vein thrombosis (DVT) is consistent finding.

Case report: A 29-year-old male patient presented with recurrent lower extremity ulcers. Further workup revealed an absent infrahepatic inferior vena cava, prominently dilated azygos and hemiazygos veins with enlarged retroperitoneal collaterals without DVT.

Conclusion: IVC anomaly should be suspected in a young patient presenting with unexplained venous thrombosis and recurrent ulcers of a lower extremity. IVC anomaly would inherently lead to blood flow stasis and endothelial injury. Thus per Virchow's triad, other risk factors for hypercoagulability such as physical inactivity, smoking tobacco, oral contraceptive pills should be avoided and when hereditary thrombophilias or other irreversible risk factors are present, lifelong anticoagulation should be considered.

No MeSH data available.


Related in: MedlinePlus