Vnitr Lek 2009, 55(12):1189-1192

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

A. Halčín^1,*, E. Kováčová¹, F. Mikla¹, A. Reptová¹, J. Bedeová²

¹ I. interná klinika Lekárskej fakulty UK a FNsP Bratislava, pracovisko Staré mesto, Slovenská republika, prednosta doc. MUDr. Soňa Kiňová, PhD.

² I. rádiologická klinika Lekárskej fakulty UK a FNsP Bratislava, pracovisko Staré mesto, Slovenská republika, prednosta prof. MUDr. Jozef Bilický, PhD.

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.

Keywords: agenesis; vena cava inferior; phlebothrombosis

Received: May 4, 2009; Accepted: June 22, 2009; Published: December 1, 2009  Show citation