Benign external compression of the inferior vena cava associated with thrombus formation

England, Rachel; Wells, I.P.; Gutteridge, C

doi:10.1259/bjr/21010811

Cited by 25 publications

(14 citation statements)

References 12 publications

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“…Iguchi et al demonstrated a similar presentation of compression leading to obstruction from a hepatic cyst with intra-cystic hemorrhage that was managed with a heparin drip and bridging to warfarin 6 . England et al, demonstrated the extremes of treatment for this condition, from oral anticoagulation alone to open operative removal of clot burden 2 . We present the first case of management of IVC thrombus secondary to external compression by a simple hepatic cyst by means of tPA infusion and mechanical thrombectomy.…”

Section: Discussionmentioning

confidence: 78%

“…Thrombosis is typically an extension of a deep vein thrombosis; however, there are other isolated causes of occlusion. Thrombus causing occlusion of the inferior vena cava (IVC) is a known complication of malignancy, whether due to the hypercoaguable state that malignancy produces or due to the direct extension of the tumor burden 2 . Benign causes of occlusion are a rarer event.…”

Section: Introductionmentioning

confidence: 99%

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Simple hepatic cyst causing inferior vena cava thrombus

Musielak

Singh

Hartman

et al. 2014

International Journal of Surgery Case Reports

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INTRODUCTIONThrombosis of the inferior vena cava (IVC) is governed by Virchow's triad of stasis of blood flow, endothelial damage and hypercoagulability. Causes may be secondary to malignancy, congenital anomalies or other infrequent events such as external compression. We present a case of external compression of the IVC leading to extensive thrombus burden secondary to a benign hepatic cyst.PRESENTATION OF CASEA 72 year old African American female presented to the emergency department with new onset shortness of breath, right lower extremity weakness and swelling. CT imaging demonstrated multiple hepatic cysts compressing the IVC, leading to extensive clot burden. Treatment with heparin drip was initiated without resolution of her symptoms. Transcatheter mechanical thrombectomy and tPA infusion was performed. After 24 h, swelling and weakness were nearly resolved. The patient was bridged to therapeutic low molecular weight heparin in preparation for surgery.DISCUSSIONManagement of IVC thrombosis has typically been with a heparin drip and transition to oral anticoagulants. Thrombolysis has been shown to promote complete clot lysis more often than compared to standard anticoagulant therapy. In addition, venous patency was better maintained.CONCLUSIONWe feel that the added benefit of short term effects of improved venous patency and long term benefits of less post thrombotic syndrome, catheter based tPA administration and mechanical thrombectomy for thrombus offers an adjuvant treatment in the setting of large clot burden refractory to standard treatment.

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Section: Discussionmentioning

confidence: 78%

Section: Introductionmentioning

confidence: 99%

Simple hepatic cyst causing inferior vena cava thrombus

Musielak

Singh

Hartman

et al. 2014

International Journal of Surgery Case Reports

View full text Add to dashboard Cite

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“…Ultrasound is the most accessible means of fol- low-up. When transluminal interventional therapy such as filter insertion or venoplasty is considered, venography remains essential (8).…”

Section: Case Presentationsmentioning

confidence: 99%

Liver abscesses with venous extension - rare complication of a common problem

Lal

Thakral²,

Sharma³

et al. 2015

Turk J Gastroenterol

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Considering the high incidence of amoebic and pyogenic liver abscess in the developing world, occurrence of inferior vena cava thrombosis secondary to liver abscess is a rare but life threatening complication. We report 4 such complicated cases of liver abscess(s). The first case involved a large caudate lobe abscess extending across middle hepatic vein into suprahepatic inferior vena cava (IVC). Development of a left hepatic artery pseudoaneurysm following attempted percutaneous aspiration highlights the difficulties encountered in percutaneous interventional management of caudate lobe abscesses. The second case involved multiple liver abscesses with large thrombus in the right ventricular cavity & right ventricular outflow tract. The patient developed cardiorespiratory arrest limiting any aggressive management options for the complex nature of illness. The third case had a large caudate lobe abscess with direct extension into Intrahepatic IVC while the fourth showed a segment 4 abscess with thrombosis of adjacent left hepatic vein. These cases highlight the fact that diagnosis of such life threatening complications of liver abscesses as hepatic vein & IVC thrombosis requires high clinical suspicion followed by targeted imaging. Image guided interventional therapy is a useful tool for management in cases of liver abscess. But, abscesses in precarious locations like caudate lobe are associated with higher risk of complications including pseudoaneurysm formation asking for a cautious approach to interventional therapy in such circumstances.

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“…IVC compression leading to thrombus formation and pulmonary embolism is rare 1. Causes include hepatobiliary malignancy and benign causes such as large cysts 1. Liver cysts are classified as simple or complex 2.…”

Section: Descriptionmentioning

confidence: 99%