Epidural Venous Enlargements Presenting With Intractable Lower Back Pain and Sciatica in a Patient With Absence of the Infrarenal Inferior Vena Cava and Bilateral Deep Venous Thrombosis

Abstract

The authors believe that epidural venous enlargements should be considered as a cause of radicular and/or back pain in patients with anomalies of the inferior vena cava, because pathologic processes compressing nervous structures can cause pain.

A very rare cause of low-back pain and sciatica: deep vein thrombosis due to absence of the inferior vena cava mimicking the clinical and radiological signs of lumbar disc herniation

“…3,4,16 Moreover, in our patient, sciatica was the first clinical manifestation and led to the identification of this vascular anomaly.…”

“…[3][4][5]7,9,10,17 Several underlying pathologies, such as thrombosis or occlusion of the IVC, 10 IVC compression due to pregnancy, 6 and portal hypertension, account for epidural venous engorgements associated with low-back pain and sciatica.…”

“…1,2,8,[11][12][13][14] Here we present the case of a 21-year-old man who presented with acute low-back pain and sciatica due to lumbar varices and intraspinal epidural venous engorgements primarily caused by absence of the infrarenal IVC associated with iliofemoral vein thrombosis. Epidural varicose veins causing low-back pain and radiculopathy have been described; [3][4][5]7,9,10,17 they develop either primarily or secondarily due to IVC obstruction or thrombosis. However, formation of epidural varices with concomitant iliofemoral vein thrombosis caused by absence of the infrarenal segment of the IVC as a primary cause of low-back pain and sciatica represents a very rare clinical entity.…”

Venous sinus thrombosis secondary to tuberculous meningitis: a novel cause of trigeminal neuralgia

“…To the best of our knowledge, no other such case has been reported in the literature, however two cases of TN secondary to a TB of the CPA have been described 3 4. Also, lower back pain and sciatica from spinal nerve root compression by epidural venous enlargement secondary to venous thrombosis, was described by Dudeck et al 5. Although this is in a different location to our case, they both demonstrate low flow systems causing nerve root compression with resultant pain.…”

Lumbar Epidural Varix Mimicking Perineural Cyst

“…A herniated disc material may occlude an epidural vein; subsequently venous dilatation can occur as a result of the valveless nature of the epidural venous plexus [5]. In addition, portocaval hypertension, thrombosis of the inferior vena cava and agenesis of infrarenal segment of inferior vena cava may be responsible for the development of lumbar epidural varix [5-7]. In our case, we performed MR-venography after the operation, but could not find any obstruction or agenesis in the inferior vena cava.…”