Abstract

We describe the case of a 17 year old male who presented with severe groin pain leading to inability to weight bear on his left leg. Investigation revealed extensive bilateral and proximal deep vein thrombosis, in association with an absent inferior vena cava and anomalous venous drainage system. We present a review of the literature surrounding this association, summarise the typical clinical presentation and common characteristics in this group of patients and discuss its management.
[download-attachments container="div" style="list" display_icon="1" display_count="1" display__size="0"]

References

1. Spencer FA, Emery C, Joffe SW et al. Incidence rates, clinical profile, and outcomes of patients with venous thromboembolism. The Worcester VTE study. J Thromb Thrombolysis 2009; 28: 401–409.
2. Minniti S, Visentini S and Procacci C. Congenital anomalies of the venae cavae:embryological origin, imaging features and report of three new variants. Eur Radiol 2002; 12: 2040–2055.
3. Kellman GM, Alpern MB, Sandler MA et al. Computed tomography of vena caval anomalies with embryologic correlation. Radiographics 1988; 8: 533–556.
4. White RH. The epidemiology of venous thromboembolism. Circulation 2003; 107: I4–I8.
5. Rosendaal FR. Thrombosis in the young: epidemiology and risk factors. A focus on venous thrombosis. Thromb Haemost 1997; 78: 1–6.
6. Chee YL, Dominic J, Watson CG et al. Inferior vena cava malformations as risk factors for deep venous thrombosis in the young. 2001; 114: 878–880.
7. Iqbal J and Nagaraju E. Congenital absence of inferior vena cava and thrombosis: a case report. J Med Case Reports 2008; 2: 46.
8. Gayer G, Luboshitz J, Hertz M et al. Congenital anomalies of the inferior vena cava revealed on CT in patients with deep vein thrombosis. AJR 2003; 180: 729–732.
9. Baeshko AA, Zhuk HV, Ulezko EA et al. Congenital anomalies of the inferior vena cava and their clinical manifestation. EJVES 2007; 14: 8–13.
10. Obernosterer A, Aschauer M, Schnedl W et al. Anomalies of the inferior vena cava in patients with iliac venous thrombosis. Ann Intern Med 2002; 136: 37–41.
11. Yigit H, Yagmurlu B, Yigit N et al. Low back pain as the initial symptom of inferior vena cava agenesis. Am J Neuroradiol 2006; 27: 593–595.
12. 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.
13. Dean SM and Tytle TL. Acute right lower extremity iliofemoral deep venous thrombosis secondary to an anomalous inferior vena cava: a report of two cases. Vascular Medicine 2006; 11: 165–169..
14. Vucicevic Z, Degoricija V and Alfirevic Z et al. Inferior vena cava agenesia and massive bilateral iliofemoral venous thrombosis. Angiology 2008; 59: 510–513.
15. Simon RW, Amann-Vesti BR, Pfammatter T et al. Congenital absence of the inferior vena cava:A rare risk factor for idiopathic deep-vein thrombosis. J Vasc Surg 2006; 44: 416.
16. Casella IB, Bosch MA and Sabbag CR. Incidence and risk factors for bilateral deep venous thrombosis of the lower limbs Angiology 2009; 60: 99–103.
17. Pennell RC, Mantese VA and Westfall SG. Duplex scan for deep vein thrombosis-defining who needs an examination of the contralateral asymptomatic leg. J Vasc Surg 2008; 48: 413–416.