Case Report: Inferior Vena Cava Agenesia in a Young Male Patient Presenting With Bilateral Iliac Veins Thrombosis
IntroductionAnomalies in inferior vena cava represent an uncommon finding with a prevalence of 0. 3 to 0.5% among healthy patients. Specifically, the condition characterized by the agenesis of the inferior vena cava (IVC; AIVC) has been observed among the 0.0005 to 1% of the general population. AIVC...
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Frontiers Media S.A.
2022-03-01
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| Series: | Frontiers in Surgery |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fsurg.2022.832336/full |
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| author | Edoardo Pasqui Gianmarco de Donato Silvia Camarri Raffaele Molinari Irene Cascinelli Veronica Pelini Luigi Abate Giancarlo Palasciano |
| author_facet | Edoardo Pasqui Gianmarco de Donato Silvia Camarri Raffaele Molinari Irene Cascinelli Veronica Pelini Luigi Abate Giancarlo Palasciano |
| author_sort | Edoardo Pasqui |
| collection | DOAJ |
| description | IntroductionAnomalies in inferior vena cava represent an uncommon finding with a prevalence of 0. 3 to 0.5% among healthy patients. Specifically, the condition characterized by the agenesis of the inferior vena cava (IVC; AIVC) has been observed among the 0.0005 to 1% of the general population. AIVC is strongly related to deep vein thrombosis (DVT) of the lower limb and pelvic district, especially in young patients. The rarity of the presented condition could relate to an underestimation of its impact on a particular clinical setting leading to a delayed diagnosis and inaccurate early- and long-term management.ReportWe presented a case of this anomaly regarding a 31-year-old man presenting with bilateral symptomatic proximal DVT. Duplex vascular ultrasound and subsequent CT-angiography revealed the complete occlusion of the right external and common iliac vein, as well as partial occlusion of the contralateral external iliac vein, in the patient. The exam also revealed the interruption of IVC in its infrarenal part. At the level of renal veins coalescence, IVC appeared again in its usual position. A dilatated portal system, hepatic veins, and azygos and hemiazygos systems were also highlighted. Anticoagulation was promptly started with the administration of Fondaparinux (7.5 mg/die). In addition, compression stocking was initiated within 24 h from diagnosis. After 3 weeks, the anticoagulation regimen was shifted toward the administration of a direct oral anticoagulant (Apixaban; 5 mg two times a day). At 1-month follow-up, a vascular duplex ultrasound revealed a complete resolution of the iliac veins' thrombosis.ConclusionIt is important to consider the eventuality of IVC anomalies in a young adult presenting with unexplained, extensive, or bilateral DVT. Accurate diagnostic evaluation is necessary to fully identify this condition that could represent a real challenge. |
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| format | Article |
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| institution | Directory Open Access Journal |
| issn | 2296-875X |
| language | English |
| last_indexed | 2024-12-13T19:25:01Z |
| publishDate | 2022-03-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Surgery |
| spelling | doaj.art-24a87d89922f46a19de03eccab47b5432022-12-21T23:34:04ZengFrontiers Media S.A.Frontiers in Surgery2296-875X2022-03-01910.3389/fsurg.2022.832336832336Case Report: Inferior Vena Cava Agenesia in a Young Male Patient Presenting With Bilateral Iliac Veins ThrombosisEdoardo Pasqui0Gianmarco de Donato1Silvia Camarri2Raffaele Molinari3Irene Cascinelli4Veronica Pelini5Luigi Abate6Giancarlo Palasciano7Department of Vascular Surgery, University of Siena, Siena, ItalyDepartment of Vascular Surgery, University of Siena, Siena, ItalyDivision of Internal Medicine, Associated Hospitals in Val di Chiana, Montepulciano, ItalyDivision of Internal Medicine, Associated Hospitals in Val di Chiana, Montepulciano, ItalyDivision of Internal Medicine, Associated Hospitals in Val di Chiana, Montepulciano, ItalyDivision of Radiology, Associated Hospitals in Val di Chiana, Montepulciano, ItalyDivision of Internal Medicine, Associated Hospitals in Val di Chiana, Montepulciano, ItalyDepartment of Vascular Surgery, University of Siena, Siena, ItalyIntroductionAnomalies in inferior vena cava represent an uncommon finding with a prevalence of 0. 3 to 0.5% among healthy patients. Specifically, the condition characterized by the agenesis of the inferior vena cava (IVC; AIVC) has been observed among the 0.0005 to 1% of the general population. AIVC is strongly related to deep vein thrombosis (DVT) of the lower limb and pelvic district, especially in young patients. The rarity of the presented condition could relate to an underestimation of its impact on a particular clinical setting leading to a delayed diagnosis and inaccurate early- and long-term management.ReportWe presented a case of this anomaly regarding a 31-year-old man presenting with bilateral symptomatic proximal DVT. Duplex vascular ultrasound and subsequent CT-angiography revealed the complete occlusion of the right external and common iliac vein, as well as partial occlusion of the contralateral external iliac vein, in the patient. The exam also revealed the interruption of IVC in its infrarenal part. At the level of renal veins coalescence, IVC appeared again in its usual position. A dilatated portal system, hepatic veins, and azygos and hemiazygos systems were also highlighted. Anticoagulation was promptly started with the administration of Fondaparinux (7.5 mg/die). In addition, compression stocking was initiated within 24 h from diagnosis. After 3 weeks, the anticoagulation regimen was shifted toward the administration of a direct oral anticoagulant (Apixaban; 5 mg two times a day). At 1-month follow-up, a vascular duplex ultrasound revealed a complete resolution of the iliac veins' thrombosis.ConclusionIt is important to consider the eventuality of IVC anomalies in a young adult presenting with unexplained, extensive, or bilateral DVT. Accurate diagnostic evaluation is necessary to fully identify this condition that could represent a real challenge.https://www.frontiersin.org/articles/10.3389/fsurg.2022.832336/fullinferior vena cavaagenesiadeep vein thrombosisvenous thromboembolism (VTE)anticoagulants |
| spellingShingle | Edoardo Pasqui Gianmarco de Donato Silvia Camarri Raffaele Molinari Irene Cascinelli Veronica Pelini Luigi Abate Giancarlo Palasciano Case Report: Inferior Vena Cava Agenesia in a Young Male Patient Presenting With Bilateral Iliac Veins Thrombosis Frontiers in Surgery inferior vena cava agenesia deep vein thrombosis venous thromboembolism (VTE) anticoagulants |
| title | Case Report: Inferior Vena Cava Agenesia in a Young Male Patient Presenting With Bilateral Iliac Veins Thrombosis |
| title_full | Case Report: Inferior Vena Cava Agenesia in a Young Male Patient Presenting With Bilateral Iliac Veins Thrombosis |
| title_fullStr | Case Report: Inferior Vena Cava Agenesia in a Young Male Patient Presenting With Bilateral Iliac Veins Thrombosis |
| title_full_unstemmed | Case Report: Inferior Vena Cava Agenesia in a Young Male Patient Presenting With Bilateral Iliac Veins Thrombosis |
| title_short | Case Report: Inferior Vena Cava Agenesia in a Young Male Patient Presenting With Bilateral Iliac Veins Thrombosis |
| title_sort | case report inferior vena cava agenesia in a young male patient presenting with bilateral iliac veins thrombosis |
| topic | inferior vena cava agenesia deep vein thrombosis venous thromboembolism (VTE) anticoagulants |
| url | https://www.frontiersin.org/articles/10.3389/fsurg.2022.832336/full |
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